Individual provider Active NPI

Jonathan Sol Kulbersh, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Charlotte, NC
National Provider Identifier
1124117486
Registry record updated Oct 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
2010-02022 Issued in NC
Practice address
6849 Fairview Rd
Ste 200
Charlotte, NC 28210-3393
Phone
(704) 323-5090
Fax
(704) 362-6085
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 2010-02022 NC Primary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X A112455 CA
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X MD 28074 SC
Facial Plastic Surgery Physician 207YS0123X P3373 TX

Addresses

Primary practice location

6849 Fairview Rd
Ste 200
Charlotte, NC 28210-3393

Mailing address

6849 Fairview Rd
Ste 200
Charlotte, NC 28210-3393
Phone (704) 323-5090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P3373TXMDFacial Plastic Surgery Physician
A112455CAMDOtolaryngology/Facial Plastic Surgery Physician
2010-02022NCMDOtolaryngology/Facial Plastic Surgery Physician
MD 28074SCMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ear Nose Throat & Audiology Associates Past Accepting new patients
Ear Nose Throat & Audiology Associates of the Carolinas, P.a. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350259200000",
    "number": "1124117486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6849 FAIRVIEW RD",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103393",
            "telephone_number": "704-323-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6849 FAIRVIEW RD",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103393",
            "telephone_number": "704-323-5090",
            "fax_number": "704-362-6085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULBERSH",
        "first_name": "JONATHAN",
        "middle_name": "SOL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2012-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NC",
            "license": "2010-02022",
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "CA",
            "license": "A112455",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "SC",
            "license": "MD 28074",
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "TX",
            "license": "P3373",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.