Provider Demographics
NPI:1225322274
Name:TRIANGLE SKIN CENTER OF CAROLINA PA
Entity Type:Organization
Organization Name:TRIANGLE SKIN CENTER OF CAROLINA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:KESSLER-HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-845-0333
Mailing Address - Street 1:8311 BANDFORD WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2763
Mailing Address - Country:US
Mailing Address - Phone:919-845-0333
Mailing Address - Fax:
Practice Address - Street 1:8311 BANDFORD WAY STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2763
Practice Address - Country:US
Practice Address - Phone:919-845-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800932172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty