Provider Demographics
NPI:1245578921
Name:DERMONE OF NORTH CAROLINA PA
Entity Type:Organization
Organization Name:DERMONE OF NORTH CAROLINA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP CONTRACTING & PRICING
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-864-5129
Mailing Address - Street 1:200 BARR HARBOR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2979
Mailing Address - Country:US
Mailing Address - Phone:800-337-6663
Mailing Address - Fax:
Practice Address - Street 1:1099 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7346
Practice Address - Country:US
Practice Address - Phone:910-251-9944
Practice Address - Fax:910-763-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty