Provider Demographics
NPI:1972790657
Name:NORTH CHARLOTTE PLASTIC SURGERY ASSOCIATES PA
Entity Type:Organization
Organization Name:NORTH CHARLOTTE PLASTIC SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-728-2787
Mailing Address - Street 1:7306 SWANSEA LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8696
Mailing Address - Country:US
Mailing Address - Phone:704-896-0230
Mailing Address - Fax:704-987-3709
Practice Address - Street 1:13620 REESE BLVD E
Practice Address - Street 2:BLDG XII SUITE 110
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6417
Practice Address - Country:US
Practice Address - Phone:704-896-0230
Practice Address - Fax:704-987-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare Oscar/Certification