MEDICARE: MRS. DIANNE PATRICIA SARLES

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	A4440	NC

General Provider Information

NPI Number	:	1871861419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNE PATRICIA SARLES

Provider Business Mailing Address
First Line	:	4109 MEDOC MOUNTAIN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1627
Country	:	US
Telephone Number	:	704-321-9791
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 MEDOC MOUNTAIN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1627
Country	:	US
Telephone Number	:	704-321-9791
Fax Number	:

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

Provider Enumeration Date	:	12/11/2011
Last Update Date	:	12/11/2011

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