Provider Demographics
NPI:1851416242
Name:ERVIN S. BATCHELOR, PA
Entity Type:Organization
Organization Name:ERVIN S. BATCHELOR, PA
Other - Org Name:CAROLINA CENTER FOR DEVELOPMENT AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATCHELOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-372-5997
Mailing Address - Street 1:1718 E 4TH ST
Mailing Address - Street 2:SUITE 702
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3261
Mailing Address - Country:US
Mailing Address - Phone:704-372-5997
Mailing Address - Fax:704-372-2330
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 702
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3261
Practice Address - Country:US
Practice Address - Phone:704-372-5997
Practice Address - Fax:704-372-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1659103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2819821Medicare PIN