Provider Demographics
NPI:1518952589
Name:KLOTZ, DARRELL ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:ALEXANDER
Last Name:KLOTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3253
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3253
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-00935207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2103802OtherMAMSI
NC10-00211OtherUNITED HEALTHCARE
NC13159OtherBLUE CROSS BLUE SHIELD
SC20095447OtherSELECT HEALTH OF SC
NC7340670002OtherCIGNA HEALTHCARE
NC8913159Medicaid
773673OtherWELLCARE
NCB8346OtherMEDCOST
SC01146021OtherAMERIGROUP OF SC
NC7049291OtherAETNA HEALTHPLAN
SC000000293192OtherUNISON HEALTH PLAN SC
NC180357OtherCOVENTRY HEALTHCARE
NCN00936Medicaid
NC800996OtherPARTNERS HEALTHPLAN
NC2103802OtherMAMSI
NCB8346OtherMEDCOST
NC180357OtherCOVENTRY HEALTHCARE