Provider Demographics
NPI:1831176643
Name:MECKLENBURG DERMATOLOGY ASSOC. PA
Entity type:Organization
Organization Name:MECKLENBURG DERMATOLOGY ASSOC. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:704-344-8846
Mailing Address - Street 1:309 S. SHARON AMITY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-0000
Mailing Address - Country:US
Mailing Address - Phone:704-344-8846
Mailing Address - Fax:704-369-7999
Practice Address - Street 1:309 S. SHARON AMITY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-0000
Practice Address - Country:US
Practice Address - Phone:704-344-8846
Practice Address - Fax:704-344-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952485Medicaid
NC897835EMedicaid
NC89011AXMedicaid
NC5902119Medicaid
NC89011AXMedicaid
NC208306BMedicare UPIN
NCS58084Medicare UPIN
NCF48905Medicare UPIN
NC8952485Medicaid
NC2344517Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NC2197159BMedicare ID - Type UnspecifiedDR SNYDER MEDICARE
NC897835EMedicaid
NC2746186BMedicare ID - Type UnspecifiedSHARON SWARTZ PA MEDICARE