Provider Demographics
NPI:1508395468
Name:PRESTON DERMATOLOGY & SKIN SURGERY CENTER PA
Entity Type:Organization
Organization Name:PRESTON DERMATOLOGY & SKIN SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEEL
Authorized Official - Middle Name:DESAI
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-388-9103
Mailing Address - Street 1:1010 HIGH HOUSE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3576
Mailing Address - Country:US
Mailing Address - Phone:919-263-5255
Mailing Address - Fax:919-435-8405
Practice Address - Street 1:1010 HIGH HOUSE RD STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3576
Practice Address - Country:US
Practice Address - Phone:919-388-9103
Practice Address - Fax:919-234-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00889207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty