Provider Demographics
NPI:1114044682
Name:CAROLINA SKIN & VEIN CENTER INC.
Entity Type:Organization
Organization Name:CAROLINA SKIN & VEIN CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-616-1815
Mailing Address - Street 1:7110 WRIGHSTVILLE AVENUE
Mailing Address - Street 2:SUITE B 9
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-509-4116
Mailing Address - Fax:910-509-7566
Practice Address - Street 1:7110 WRIGHTSVILLE AVE
Practice Address - Street 2:SUITE B 9
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7219
Practice Address - Country:US
Practice Address - Phone:910-509-4116
Practice Address - Fax:910-509-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600064173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954150Medicaid
NC2329947Medicare ID - Type Unspecified
NC8954150Medicaid