Provider Demographics
NPI:1538337688
Name:LAKE NORMAN NEUROLOGICAL AND SPINAL SURGERY, P.A.
Entity type:Organization
Organization Name:LAKE NORMAN NEUROLOGICAL AND SPINAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:YABLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-799-3206
Mailing Address - Street 1:134 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8526
Mailing Address - Country:US
Mailing Address - Phone:704-799-3206
Mailing Address - Fax:704-799-3287
Practice Address - Street 1:134 MEDICAL PARK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8526
Practice Address - Country:US
Practice Address - Phone:704-799-3206
Practice Address - Fax:704-799-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB40884Medicare UPIN