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1518952589

NPI Code Detail

MEDICARE: DR. DARRELL ALEXANDER KLOTZ M.D.

MEDICARE: DR. DARRELL ALEXANDER KLOTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	2002-00935	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2103802	OTHER	NC	MAMSI
2	10-00211	OTHER	NC	UNITED HEALTHCARE
3	13159	OTHER	NC	BLUE CROSS BLUE SHIELD
4	20095447	OTHER	SC	SELECT HEALTH OF SC
5	7340670002	OTHER	NC	CIGNA HEALTHCARE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	773673	OTHER		WELLCARE
8	B8346	OTHER	NC	MEDCOST
9	01146021	OTHER	SC	AMERIGROUP OF SC
10	7049291	OTHER	NC	AETNA HEALTHPLAN
11	000000293192	OTHER	SC	UNISON HEALTH PLAN SC
12	180357	OTHER	NC	COVENTRY HEALTHCARE
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	800996	OTHER	NC	PARTNERS HEALTHPLAN

General Provider Information

NPI Number	:	1518952589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRELL ALEXANDER KLOTZ M.D.

Provider Business Mailing Address
First Line	:	6035 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3256
Country	:	US
Telephone Number	:	704-295-3000
Fax Number	:	704-295-3253

Provider Business Practice Location Address
First Line	:	6035 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3256
Country	:	US
Telephone Number	:	704-295-3000
Fax Number	:	704-295-3253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	04/26/2021

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Directions to “ DR. DARRELL ALEXANDER KLOTZ M.D.” Practice Location

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