Individual
KELLY LYNN VANDERHAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1025 MOREHEAD MEDICAL DRIVE, SUITE 300, CHARLOTTE, NC 28204-2966
(704) 355-5982
(704) 355-5984
Mailing address
PO BOX 601372, CHARLOTTE, NC 28260-1372
(704) 355-5982
(704) 355-5984
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2012-02054
NC
207X00000X
Orthopaedic Surgery Physician
4301069717
MI
207X00000X
Orthopaedic Surgery Physician
MD190912
OR
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
2012-02054
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053375170
—
NC
05
—
5922062
—
NC
05
—
NC1738
—
SC
Enumeration date
04/14/2006
Last updated
10/20/2025
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