Mid-Charlotte Dermatology and Research PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

23521 Issued in NC

Legal business name

MID-CHARLOTTE DERMATOLOGY AND RESEARCH PLLC

Practice address

6406 Carmel Rd Ste 309
Charlotte, NC 28226-8267

Phone

(704) 367-9777

Fax

(704) 367-0504

NPI assigned

Sep 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Irene Elizabeth Edwards, MDNPI 1992857346

Title

Owner

Phone

(704) 367-9777

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Southeast Vulvar Clinic Other name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Irene Elizabeth Edwards, MD

  • Dermatology Physician
  • Charlotte, NC
  • NPI 1992857346
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1497940944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6406 CARMEL RD STE 309",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282268267",
            "telephone_number": "704-367-9777",
            "fax_number": "704-367-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6406 CARMEL RD STE 309",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282268267",
            "telephone_number": "704-367-9777",
            "fax_number": "704-367-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-CHARLOTTE DERMATOLOGY AND RESEARCH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-367-9777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NC",
            "license": "23521",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "23521",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "23521",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5922883",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Vulvar Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dermatology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.