Organization
RIVA AESTHETIC DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERRY MARK SHAFRAN M.D. (MANAGING PHYSICIAN)
(704) 607-1518
Entity
Organization
Contact information
Practice address
17039 KENTON DR, SUITE 100, CORNELIUS, NC 28031-5775
(704) 607-1518
Mailing address
17039 KENTON DR, SUITE 100, CORNELIUS, NC 28031-5775
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
39997
NC
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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