Provider Demographics
NPI:1033436423
Name:BARRETT, DANE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:MICHAEL
Last Name:BARRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3362
Mailing Address - Country:US
Mailing Address - Phone:919-620-4700
Mailing Address - Fax:
Practice Address - Street 1:3116 N DUKE ST
Practice Address - Street 2:SUITE 25A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2102
Practice Address - Country:US
Practice Address - Phone:919-660-2324
Practice Address - Fax:919-660-2362
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD170496207Y00000X, 207YX0905X
NC2016-00549207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery