Provider Demographics
NPI:1346537180
Name:ALAMANCE DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:ALAMANCE DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-395-2143
Mailing Address - Street 1:480 W WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-3700
Mailing Address - Country:US
Mailing Address - Phone:336-226-8000
Mailing Address - Fax:336-228-7585
Practice Address - Street 1:480 W WEBB AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3700
Practice Address - Country:US
Practice Address - Phone:336-226-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917993Medicaid
NC5917993Medicaid