Provider Demographics
NPI:1215180245
Name:NORTH CAROLINA DERMATOLOGY & LASER CLINIC, PLLC
Entity Type:Organization
Organization Name:NORTH CAROLINA DERMATOLOGY & LASER CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-562-6804
Mailing Address - Street 1:640 SUMMIT CROSSING PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2138
Mailing Address - Country:US
Mailing Address - Phone:704-810-0016
Mailing Address - Fax:704-810-0546
Practice Address - Street 1:640 SUMMIT CROSSING PL
Practice Address - Street 2:SUITE 204
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2138
Practice Address - Country:US
Practice Address - Phone:704-810-0016
Practice Address - Fax:704-810-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty