Provider Demographics
NPI:1417404344
Name:CHARLOTTE FACIAL PLASTIC SURGERY
Entity Type:Organization
Organization Name:CHARLOTTE FACIAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-431-1644
Mailing Address - Street 1:1819 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5103
Mailing Address - Country:US
Mailing Address - Phone:910-431-1644
Mailing Address - Fax:
Practice Address - Street 1:1819 LYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5103
Practice Address - Country:US
Practice Address - Phone:910-431-1644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty