Provider Demographics
NPI:1346036431
Name:ROWAN DIAGNOSTIC CLINIC P.A.
Entity type:Organization
Organization Name:ROWAN DIAGNOSTIC CLINIC P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-633-7220
Mailing Address - Street 1:611 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2705
Mailing Address - Country:US
Mailing Address - Phone:704-633-7220
Mailing Address - Fax:704-647-0515
Practice Address - Street 1:420 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2712
Practice Address - Country:US
Practice Address - Phone:704-633-7220
Practice Address - Fax:704-647-0515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROWAN DIAGNOSTIC CLINIC P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty