Individual
ADOLFO RICHARD DESANDRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
257 HOSPITAL DRIVE SUITE 200, BOLIVIA, NC 28422-8411
(910) 721-4000
(910) 721-4001
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
20712
SC
208600000X
Surgery Physician
Primary
9801631
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20712
SC MEDICAL LICENSE
SC
05
—
8911805
—
NC
01
—
9801631
NC MEDICAL LICENSE
NC
Enumeration date
12/15/2005
Last updated
05/11/2023
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