PEDIATRIC SURGICAL ASSOCIATES, P.A. (NPI# 1174640163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174640163 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC SURGICAL ASSOCIATES, P.A. |
| Practice Address |
1900 Randolph Rd Ste 210 Charlotte NC 28207-1106 |
| Mailing Address |
1900 Randolph Rd Ste. 210 Charlotte NC 28207-1106 |
| Practice Telephone | 7043700223 |
| Practice Fax Number | 7043700799 |
| Mailing Telephone | 7043700223 |
| Mailing Fax Number | 7043700799 |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. LINDA G. BOYD (ADMINISTRATOR) |
| Authorized Official Telephone | 7043700223 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
73120 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 890182W | 05 | |
| SC | NPA716 | 05 |
| Street Address |
1900 RANDOLPH RD STE 210 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28207-1106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881689362 | Barbara Elizabeth Kissam | Pediatrics | 1900 Randolph Rd, Suite 1010, Charlotte, NC 28207-1122 | 2005-09-12 |
| 1144769332 | Courtney Wiseman | Physician Assistant | 1900 Randolph Rd, Suite 800, Charlotte, NC 28207-1122 | 2017-02-21 |
| 1700339785 | Yu Wei Shan | Nurse Practitioner | 1900 Randolph Rd, Suite 800, Charlotte, NC 28207-1122 | 2016-07-26 |
| 1891182127 | Novant Medical Group,inc | Pediatrics | 1900 Randolph Rd, Suite 300, Charlotte, NC 28207-1122 | 2015-04-24 |
| 1578979936 | Kristen Elizabeth Bush | Physician Assistant | 1900 Randolph Rd, Ste 900, Charlotte, NC 28207-1122 | 2014-07-07 |
| 1003235524 | Novant Medical Group Inc | Internal Medicine | 1900 Randolph Rd, Suite 216, Charlotte, NC 28207-1122 | 2014-04-11 |
| 1508107863 | Novant Medical Group Inc | Internal Medicine | 1900 Randolph Rd, Suite 300, Charlotte, NC 28207-1106 | 2013-03-12 |
| 1639422264 | Anthony James Mignanelli II | Nurse Practitioner | 1900 Randolph Rd, Suite 900, Charlotte, NC 28207-1122 | 2012-10-19 |
| 1851642169 | Meagan Marie Bullock | Social Worker | 1900 Randolph Rd, Suite 800, Charlotte, NC 28207-1122 | 2012-09-26 |
| 1114299294 | Worley Shaun Lynch | Physician Assistant | 1900 Randolph Rd, Suite 900, Charlotte, NC 28207-1122 | 2012-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
| 1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
| 1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
| 1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
| 1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
| 1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
| 1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| 1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
| 1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
| Find all providers in zip 28207 | ||||
| Taxonomy Code | 2086S0120X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Pediatric Surgery |
| A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225525538 | Jessica Marie Pierce | Surgery | 1900 Randolph Rd Ste 210, Charlotte, NC 28207-1106 | 2018-04-23 |
| 1346376423 | Daniel Andrew Bambini | Surgery | 1900 Randolph Rd., Ste. 210, Charlotte, NC 28207-1106 | 2007-02-26 |
| 1194157388 | Carolinas Physicians Network Inc | Surgery | 1025 Morehead Medical Dr, Ste 275, Charlotte, NC 28204-2963 | 2013-07-30 |
| 1275741076 | Graham Harvey Cosper | Surgery | 1900 Randolph Rd., Ste. 210, Charlotte, NC 28207-1106 | 2007-05-18 |
| 1619012150 | Duncan Morton Jr. | Surgery | 1900 Randolph Rd, Suite 210, Charlotte, NC 28207-1106 | 2007-02-21 |
| 1922182492 | Andrew Schulman | Surgery | 1900 Randolph Road, Ste 210, Charlotte, NC 28207-1106 | 2006-10-24 |
| 1689763393 | Paul Kirshbom | Surgery | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2006-10-12 |
| 1467466961 | Michael J. Goretsky | Surgery | 1025 Morehead Medical Dr, Suite 275, Charlotte, NC 28204-2963 | 2006-07-28 |
| 1154371151 | Steven Teich | Surgery | 1025 Morehead Medical Dr, Ste 275, Charlotte, NC 28204-2963 | 2006-05-11 |
| 1700840469 | John W Difiore | Surgery | 1025 Morehead Medical Dr, Suite 275, Charlotte, NC 28204-2963 | 2006-04-12 |
| Find all providers in CHARLOTTE | ||||
Please comment or provide details below to improve the information on PEDIATRIC SURGICAL ASSOCIATES, P.A..
| 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.