MEDICARE: MR. WILLIAM CHARLES O'CONNOR JR. 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	363A00000X	Physician Assistant	001011006	NC
2	207N00000X	Dermatology Physician	001011006	NC

General Provider Information

NPI Number	:	1942892369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CHARLES O'CONNOR JR. PA

Provider Business Mailing Address
First Line	:	11301 GOLF LINKS DR N STE 203
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8014
Country	:	US
Telephone Number	:	704-321-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 GOLF LINKS DR N STE 203
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8014
Country	:	US
Telephone Number	:	704-321-3376
Fax Number	:

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

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	04/21/2021

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