Provider Demographics
NPI:1316056104
Name:PIEDMONT PLASTIC SURGERY AND DERMATOLOGY
Entity type:Organization
Organization Name:PIEDMONT PLASTIC SURGERY AND DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-484-0464
Mailing Address - Street 1:959 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3420
Mailing Address - Country:US
Mailing Address - Phone:704-866-7576
Mailing Address - Fax:704-866-0106
Practice Address - Street 1:700 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3829
Practice Address - Country:US
Practice Address - Phone:704-484-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0138TOtherBCBS
NC8966460Medicaid
NC2325703Medicare PIN
NC0138TOtherBCBS