MEDICARE: MECKLENBURG DERMATOLOGY ASSOC. 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	174400000X	Specialist	9400642	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831176643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MECKLENBURG DERMATOLOGY ASSOC. PA

Provider Business Mailing Address
First Line	:	309 S. SHARON AMITY
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-0000
Country	:	US
Telephone Number	:	704-344-8846
Fax Number	:	704-369-7999

Provider Business Practice Location Address
First Line	:	309 S. SHARON AMITY
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-0000
Country	:	US
Telephone Number	:	704-344-8846
Fax Number	:	704-344-9844

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SHARON M. SWARTZ
Credential	:	PA-C
Telephone Number	:	704-344-8846

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	06/26/2012

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