Organization
LAKE NORMAN PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM G RAVIN MD (OWNER)
(704) 658-9921
Entity
Organization
Contact information
Practice address
LAKE NORMAN MEDICAL & PROFESSIONAL PLAZA, SUITE 106, 146 MEDICAL PARK RD., MOORESVILLE, NC 28117
(704) 658-9921
(704) 658-9928
Mailing address
PO BOX 15133, DURHAM, NC 27704-0133
(919) 477-5152
(919) 477-5474
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143AR
BLUE CROSS AND BLUE SHIEL
NC
01
—
DO2646
RAILROAD MEDICARE
NC
01
—
P00667059
RAILROAD MEDICARE
NC
Enumeration date
07/01/2006
Last updated
03/05/2009
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