Provider Demographics
NPI:1619208345
Name:CENTRAL CAROLINA SKIN & DERMATOLOGY CENTER PA
Entity Type:Organization
Organization Name:CENTRAL CAROLINA SKIN & DERMATOLOGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BENITEZ-GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-304-5900
Mailing Address - Street 1:3940 ARROWHEAD BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7636
Mailing Address - Country:US
Mailing Address - Phone:919-304-5900
Mailing Address - Fax:919-304-5901
Practice Address - Street 1:3940 ARROWHEAD BLVD
Practice Address - Street 2:STE 210
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7636
Practice Address - Country:US
Practice Address - Phone:919-304-5900
Practice Address - Fax:919-304-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty