KELLY L VANDERHAVE (NPI# 1053375170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053375170 |
| Entity Type | Individual |
| Full Name | KELLY L VANDERHAVE |
| Credential | MD |
| Practice Address |
1025 Morehead Medical Drive Suite 300 Charlotte NC 28204-2966 |
| Mailing Address |
Po Box 601372 Charlotte NC 28260-1372 |
| Practice Telephone | 7043555982 |
| Practice Fax Number | 7043555984 |
| Mailing Telephone | 7043555982 |
| Mailing Fax Number | 7043555984 |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2019-06-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 2012-02054 | NC | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 4301069717 | MI | Allopathic & Osteopathic Physicians |
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
2012-02054 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5922062 | 05 | |
| SC | NC1738 | 05 | |
| NC | 1053375170 | 05 |
| Street Address |
1025 MOREHEAD MEDICAL DRIVE SUITE 300 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28204-2966 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972149946 | Christoph Tschuor | Surgery | 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204 | 2019-11-25 |
| 1720644354 | Eva Barbara Deerenberg | Surgery | 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204 | 2019-05-20 |
| 1306223425 | Daphne Louise Capek | Obstetrics & Gynecology | 1025 Morehead Medical Drive, Suite 450, Charlotte, NC 28204 | 2015-04-27 |
| 1528455243 | Patrick Moody | Orthopaedic Surgery | 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204-2966 | 2015-04-21 |
| 1366768152 | Mecklenburg Medical Group | Dermatology | 1025 Morehead Medical Drive, Suite 200, Charlotte, NC 28204-2965 | 2010-04-19 |
| 1114242088 | Mecklenburg Medical Group | Internal Medicine | 1025 Morehead Medical Drive, Suite 200, Charlotte, NC 28204-2965 | 2010-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285263582 | Precise Home Care Service LLC | In Home Supportive Care | 1935 Baxter Street, Unit 101, Charlotte, NC 28204 | 2020-04-07 |
| 1285276253 | Shannon Miller | Counselor | 1432 E Seventh Street, Charlotte, NC 28204 | 2019-10-11 |
| 1194282202 | Madison Joann Mcgarrigle | Behavior Technician | 1401 East 7th Street, Charlotte, NC 28204 | 2019-02-25 |
| 1255802674 | Stacey D. Alston, Dds, Pa | Dentist | 1020 E. 10th St., Suite 1, Charlotte, NC 28204 | 2018-12-11 |
| 1972082097 | Kim Webb Talbert | Nurse Practitioner | Novant Health Presbyterian Medical Center Charlotte, 200 Hawthorne Lane, Charlotte, NC 28204 | 2018-08-09 |
| 1164910535 | Jesse Elijah Roberts | Counselor | 1801 E 5th Street, #208, Charlotte, NC 28204 | 2018-05-01 |
| 1336696848 | Eight Healthcare | Exclusive Provider Organization | 2455 Weddington Ave, 2110, Charlotte, NC 28204 | 2016-09-01 |
| 1225480551 | Kathleen Quintana Bradley | Physician Assistant | 1523 Elizabeth Ave., Suite 200, Charlotte, NC 28204 | 2016-07-11 |
| 1184049777 | Della Franklin | Speech-Language Pathologist | 1021 Morehead Medical Dr Ste 3300, Charlotte, NC 28204 | 2014-02-19 |
| 1225459845 | Healing Arts Medical, Pa | Family Medicine | 335 N. Caswell Rd., Charlotte, NC 28204 | 2013-12-27 |
| Find all providers in zip 28204 | ||||
| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548223092 | Joseph John Estwanik | Orthopaedic Surgery | 335 Billingsley Rd, Charlotte, NC 28211-1040 | 2006-04-07 |
| 1972737195 | Novant Medical Group Inc | Orthopaedic Surgery | 2826 Randolph Rd, Charlotte, NC 28211-1386 | 2009-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902241805 | Ian Al'khafaji | Orthopaedic Surgery | 2719 Reynolda Rd, Winston Salem, NC 27106 | 2013-05-06 |
| 1821354812 | Sunny Patel | Orthopaedic Surgery | 1234 Huffman Mill Rd Dept Of, Burlington, NC 27215 | 2012-04-04 |
| 1174763981 | Brett Andrew Fritsch | Orthopaedic Surgery | Duke Sports Medicine Ctr, 300 Frank Bassett Drive, Durham, NC 27710-0001 | 2009-03-06 |
| 1033366885 | Scotland Orthopedics, Pa | Orthopaedic Surgery | 410 D South Jones Street, Pembroke, NC 28372 | 2008-08-23 |
| 1437315165 | North Carolina Shoulder and Elbow Surgery and Sports Medicine | Orthopaedic Surgery | 900 North Howe St, Southport, NC 28461 | 2008-08-01 |
| 1750542411 | Abby B. Maxwell | Orthopaedic Surgery | 3 Mcdowell St, Suite B, Asheville, NC 28801-4103 | 2008-06-24 |
| 1518130418 | Jeffrey Tweed Spang | Orthopaedic Surgery | University of North Carolina Hospital, Cb# 7055, Chapel Hill, NC 27599-7055 | 2008-04-11 |
| 1184746810 | Kevin Leo Krasinski | Orthopaedic Surgery | 1236 Huffman Mill Rd Ste 1300, Burlington, NC 27215-8700 | 2007-04-04 |
| 1285748970 | Statesville Hma Physician Management, Inc | Orthopaedic Surgery | 340 Signal Hill Dr, Suite A, Statesville, NC 28625-4357 | 2006-08-18 |
| 1467461566 | Timothy Ned Taft | Orthopaedic Surgery | 3154 Bioinformatics Bldg, Cb # 7055 Unc, Chapel Hill, NC 27599-0001 | 2006-08-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.