Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 200201121 | NC |
Y | 2081S0010X | Sports Medicine | 200201121 | NC |
Y | 213ES0000X | Sports Medicine | 200201121 | NC |
NPI | 1386633188 |
---|---|
Provider Name | Frank E Lorch IV |
First Address | Charlotte, NC 28260-2148 |
Second Address | Charlotte, NC 28211-1365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 30/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1386633188 | (05) | NC |
891321A | (05) | NC |
G10296 | (02) | |
N01126 | (05) | SC |