Provider Demographics
NPI:1558515965
Name:CHARLOTTE DERMATOPATHOLOGY, INC
Entity type:Organization
Organization Name:CHARLOTTE DERMATOPATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:DARST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-760-0323
Mailing Address - Street 1:PO BOX 78380
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28271-7031
Mailing Address - Country:US
Mailing Address - Phone:937-321-3376
Mailing Address - Fax:
Practice Address - Street 1:11301 GOLF LINKS DR N
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8013
Practice Address - Country:US
Practice Address - Phone:937-321-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory