Organization
PALMETTO PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL L. WIENS (SENIOR VICE PRESIDENT OF OPERATIONS)
(704) 355-0648
Entity
Organization
Contact information
Practice address
9332 S TRYON ST, CHARLOTTE, NC 28273-3108
(803) 327-5772
(803) 327-9303
Mailing address
PO BOX 601251, CHARLOTTE, NC 28260-1251
(803) 327-5772
(803) 327-9303
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NPB360
—
SC
Enumeration date
12/21/2009
Last updated
03/05/2010
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