Provider Demographics
NPI:1508882796
Name:CHAPEL HILL DERMATOLOGY, PA
Entity Type:Organization
Organization Name:CHAPEL HILL DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-942-3106
Mailing Address - Street 1:891 WILLOW DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7077
Mailing Address - Country:US
Mailing Address - Phone:919-942-3106
Mailing Address - Fax:919-967-1674
Practice Address - Street 1:891 WILLOW DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7077
Practice Address - Country:US
Practice Address - Phone:919-942-3106
Practice Address - Fax:919-967-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCM4284OtherRETIRED RR MEDICARE
NC8901283Medicaid
NCCM4284OtherRETIRED RR MEDICARE