Provider Demographics
NPI:1437301116
Name:NORTH CHARLOTTE PLASTIC & RECONSTRUCTIVE SURGERY, P.A.
Entity Type:Organization
Organization Name:NORTH CHARLOTTE PLASTIC & RECONSTRUCTIVE SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-896-5556
Mailing Address - Street 1:9735 KINCEY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9118
Mailing Address - Country:US
Mailing Address - Phone:704-896-5556
Mailing Address - Fax:704-896-5585
Practice Address - Street 1:9735 KINCEY AVE STE 104
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9118
Practice Address - Country:US
Practice Address - Phone:704-896-5556
Practice Address - Fax:704-896-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00556208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2023138AMedicare UPIN