Provider Demographics
NPI:1033186176
Name:CAROLINA SKIN SURGERY CENTER PA
Entity Type:Organization
Organization Name:CAROLINA SKIN SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:CARRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-295-0000
Mailing Address - Street 1:2615 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4376
Mailing Address - Country:US
Mailing Address - Phone:704-295-0000
Mailing Address - Fax:704-295-0005
Practice Address - Street 1:2615 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4376
Practice Address - Country:US
Practice Address - Phone:704-295-0000
Practice Address - Fax:704-295-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty