Provider Demographics
NPI:1346790821
Name:CAROLINAS SKIN CENTER PA
Entity Type:Organization
Organization Name:CAROLINAS SKIN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NOWICKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:980-254-8405
Mailing Address - Street 1:3315 SPRINGBANK LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-997-7070
Mailing Address - Fax:704-997-7069
Practice Address - Street 1:3315 SPRINGBANK LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-997-7070
Practice Address - Fax:704-997-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2010838OtherMEDICARE PTAN NUMBER
NC891317VMedicaid
NC891317VMedicaid