Individual
DR. SAMUEL JAY PERETSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 QUEENS RD, CHARLOTTE, NC 28204-3217
(704) 372-5180
(704) 376-6280
Mailing address
PO BOX 36488, CHARLOTTE, NC 28236-6488
(704) 248-3400
(704) 337-8387
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
89031
SC
208800000X
Urology Physician
Primary
9500688
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10465
PARTNERS PROVIDER #
NC
01
—
340016821
RAILROAD MEDICARE INDI #
NC
01
—
66833
BCBS INDI PROVIDER #
NC
Enumeration date
06/05/2006
Last updated
05/30/2023
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