Provider Demographics
NPI:1033195789
Name:DERMATOLOGY SPECIALISTS PA
Entity Type:Organization
Organization Name:DERMATOLOGY SPECIALISTS PA
Other - Org Name:HOPE M GRUBER MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-632-9272
Mailing Address - Street 1:4527 JESSUP GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9407
Mailing Address - Country:US
Mailing Address - Phone:336-632-9272
Mailing Address - Fax:866-554-1610
Practice Address - Street 1:4527 JESSUP GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9407
Practice Address - Country:US
Practice Address - Phone:336-632-9272
Practice Address - Fax:866-554-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0138AOtherBCBS
NC0A25763OtherRR MEDICARE
NC75645OtherMEDCOST
NC75645OtherMEDCOST
NC890138AMedicaid