Organization
UNIVERSITY DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERRY M SHAFRAN M.D. (MANAGING PHYSICIAN)
(704) 596-1787
Entity
Organization
Contact information
Practice address
3006 BAUCOM RD, SUITE 100, CHARLOTTE, NC 28269-6762
(704) 596-1787
(704) 596-6230
Mailing address
3006 BAUCOM RD, SUITE 100, CHARLOTTE, NC 28269-6762
(704) 596-1787
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
39997
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0179T
BLUE CROSS BLUE SHIELD
NC
Enumeration date
01/04/2007
Last updated
06/21/2018
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