Provider Demographics
NPI:1619785920
Name:NC IMMUNOLOGY, PC
Entity type:Organization
Organization Name:NC IMMUNOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LICHTENBERGER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:704-873-5055
Mailing Address - Street 1:1525 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3517
Mailing Address - Country:US
Mailing Address - Phone:704-873-5055
Mailing Address - Fax:704-873-5025
Practice Address - Street 1:1525 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3517
Practice Address - Country:US
Practice Address - Phone:704-873-5055
Practice Address - Fax:704-873-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty