Provider Demographics
NPI:1053570697
Name:DISSER, HOLLACE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLACE
Middle Name:MARIE
Last Name:DISSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 BLYTHE BLVD
Mailing Address - Street 2:MEB 3
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5812
Mailing Address - Country:US
Mailing Address - Phone:704-355-3658
Mailing Address - Fax:704-355-7047
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:MEB 3
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-3658
Practice Address - Fax:704-355-7047
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC148896207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine