Provider Demographics
NPI:1578517611
Name:ALLERGY & ASTHMA CENTER OF LAKE NORMAN, PC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CENTER OF LAKE NORMAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLURA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:704-655-1466
Mailing Address - Street 1:15815 BROOKWAY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3221
Mailing Address - Country:US
Mailing Address - Phone:704-655-1466
Mailing Address - Fax:704-655-1467
Practice Address - Street 1:15815 BROOKWAY DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3221
Practice Address - Country:US
Practice Address - Phone:704-655-1466
Practice Address - Fax:704-655-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142E4OtherBCBS
NC0007286873OtherAETNA
NC8966739OtherCIGNA
NC5903856Medicaid
NC8966739OtherCIGNA