Organization
METROLINA UROLOGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK C GARDNER MD (PRESIDENT)
(704) 358-8780
Entity
Organization
Contact information
Practice address
1900 RANDOLPH RD, SUITE 310, CHARLOTTE, NC 28207-1106
(704) 358-8780
(704) 358-1530
Mailing address
1900 RANDOLPH RD, SUITE 310, CHARLOTTE, NC 28207-1106
(704) 358-8780
(704) 358-1530
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0124P
BLUE CROSS BLUE SHIELD
—
Enumeration date
01/10/2006
Last updated
08/22/2020
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