MEDICARE: DERMATOLOGY CARE OF CHARLOTTE, PA

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	207N00000X	Dermatology Physician	9800340	NC

General Provider Information

NPI Number	:	1639195126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY CARE OF CHARLOTTE, PA

Provider Business Mailing Address
First Line	:	15830 BALLANTYNE MEDICAL PL STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0762
Country	:	US
Telephone Number	:	704-341-0090
Fax Number	:	704-341-0092

Provider Business Practice Location Address
First Line	:	15830 BALLANTYNE MEDICAL PL STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0762
Country	:	US
Telephone Number	:	704-341-0090
Fax Number	:	704-341-0092

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. JAMES L. SEWARD
Credential	:	MD
Telephone Number	:	704-821-0615

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	04/28/2023

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