Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 2016-00256 | NC |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 2016-00256 | NC |
NPI | 1750657078 |
---|---|
Provider Name | Dina Bastawros |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston Salem, NC 27103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NCT254A | (02) | NC |