Provider Demographics
NPI:1720644354
Name:DEERENBERG, EVA BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:BARBARA
Last Name:DEERENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1025 MOREHEAD MEDICAL DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-446-9253
Mailing Address - Fax:704-446-9120
Practice Address - Street 1:1025 MOREHEAD MEDICAL DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-446-9253
Practice Address - Fax:704-446-9120
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC245269208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery