Provider Demographics
NPI:1124117486
Name:KULBERSH, JONATHAN SOL (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SOL
Last Name:KULBERSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6849 FAIRVIEW RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3393
Mailing Address - Country:US
Mailing Address - Phone:704-323-5090
Mailing Address - Fax:
Practice Address - Street 1:6849 FAIRVIEW RD
Practice Address - Street 2:STE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3393
Practice Address - Country:US
Practice Address - Phone:704-323-5090
Practice Address - Fax:704-362-6085
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-02022207YX0905X
CAA112455207YX0905X
SCMD 28074207YX0905X
TXP3373207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery