Organization
CABARRUS UROLOGY CLINIC PA
Active
Other names
Northeast Urology Associates PA
Organization subpart
No
Provider details
NPI number
Authorized official
CAMERON TRENT BLACKMAN MD (SECRETARY TREASURER)
(704) 786-5131
Entity
Organization
Contact information
Practice address
1084 VINEHAVEN DR, CONCORD, NC 28025-2438
(704) 786-5131
(704) 784-4129
Mailing address
1084 VINEHAVEN DR, CONCORD, NC 28025-2438
(704) 786-5131
(704) 784-4129
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8901152
—
NC
Enumeration date
12/15/2005
Last updated
08/22/2020
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