Provider Demographics
NPI:1346452927
Name:CHARLOTTE RECONSTRUCTIVE SURGERY, PLLC
Entity Type:Organization
Organization Name:CHARLOTTE RECONSTRUCTIVE SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-971-1438
Mailing Address - Street 1:2215 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1523
Mailing Address - Country:US
Mailing Address - Phone:704-971-1438
Mailing Address - Fax:704-688-3899
Practice Address - Street 1:2215 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1523
Practice Address - Country:US
Practice Address - Phone:704-971-1438
Practice Address - Fax:704-688-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty