Provider Demographics
NPI:1396705042
Name:SOUTH CHARLOTTE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:SOUTH CHARLOTTE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKREJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-540-6860
Mailing Address - Street 1:1636 LOOKOUT CIR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8085
Mailing Address - Country:US
Mailing Address - Phone:704-540-6860
Mailing Address - Fax:
Practice Address - Street 1:10410 PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8474
Practice Address - Country:US
Practice Address - Phone:704-540-6860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-26
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty