Provider Demographics
NPI:1841837507
Name:SOUTHEAST VULVAR CLINIC, PLLC
Entity type:Organization
Organization Name:SOUTHEAST VULVAR CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:704-367-9777
Mailing Address - Street 1:6406 CARMEL ROAD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-367-9777
Mailing Address - Fax:704-367-0504
Practice Address - Street 1:6406 CARMEL ROAD
Practice Address - Street 2:SUITE 309
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-367-9777
Practice Address - Fax:704-367-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty