Provider Demographics
NPI:1689644197
Name:DERMATOLOGY ASSOCIATES OF CHARLOTTE
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-321-1595
Mailing Address - Street 1:101 E MATTHEWS ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4866
Mailing Address - Country:US
Mailing Address - Phone:704-321-1595
Mailing Address - Fax:704-321-2634
Practice Address - Street 1:101 E MATTHEWS ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4866
Practice Address - Country:US
Practice Address - Phone:704-321-1595
Practice Address - Fax:704-321-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02763OtherBCBS OF NC GROUP NUMBER
NC02763OtherBCBS OF NC GROUP NUMBER