Provider Demographics
NPI:1174783385
Name:OLSON, JONATHAN M (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:OLSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:15830 BALLANTYNE MEDICAL PL
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4653
Mailing Address - Country:US
Mailing Address - Phone:704-919-1105
Mailing Address - Fax:704-910-3163
Practice Address - Street 1:15830 BALLANTYNE MEDICAL PL
Practice Address - Street 2:SUITE 225
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4653
Practice Address - Country:US
Practice Address - Phone:704-919-1105
Practice Address - Fax:704-910-3163
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2016-09-13
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Provider Licenses
StateLicense IDTaxonomies
NC2012-02257207ND0101X
SCMD39964207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery