| NPI Details | |
|---|---|
| NPI | 1104880400 |
| Enumeration Date | 04/13/2006 |
| Last Updated | 08/18/2011 |
| Entity Type | Healthcare Provider |
| Active | Over 12 years ago |
| Authorized Information | |
|---|---|
| Name | GWEN GWEN |
| Position | OFFICE MANAGER |
| Phone | (704) 636-0971 |
| Fax | (704) 636-8554 |
| Practice Location | |
|---|---|
| 203 MOCKSVILLE AVE SUITE B SALISBURY NC, 28144-3359, US |
|
| Phone | (704) 636-0971 |
| Fax | (704) 636-8554 |
| Business Location | |
|---|---|
| PO BOX 2145 203 B MOCKSVILLE AVENUE SALISBURY NC, 28145-2145, US |
|
| Phone | (704) 636-0971 |
| Fax | (704) 636-8554 |
| Toxanomy | |
|---|---|
| Taxonomy Code | 207N00000X |
| License State | North Carolina |
| License Number | 17455 |
| Remove 1104880400 NPI Number | |
According to our database, Salisbury Dermatology Clinic, P. A. NPI is 1104880400, taxonomy code is 207N00000X and license number is 17455, license state is located at North Carolina. Salisbury Dermatology Clinic, P. A. physically located at 203 Mocksville Ave, Salisbury NC, 28144-3359. NPI Number 1033115704 has the healthcare provider type.
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1104880400 NPI number is provided on an as is basis without warranty of any kind. 1104880400 is maintained by the National Plan & Provider Enumeration System. The contents of Salisbury Dermatology Clinic, P. A. are for informational purposes only.
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