Provider Demographics
NPI:1639348592
Name:SCOTLAND DERMATOLOGY, PA
Entity Type:Organization
Organization Name:SCOTLAND DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:JOO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-276-8611
Mailing Address - Street 1:1709 BERWICK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5523
Mailing Address - Country:US
Mailing Address - Phone:910-276-8611
Mailing Address - Fax:910-276-9757
Practice Address - Street 1:1709 BERWICK DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5523
Practice Address - Country:US
Practice Address - Phone:910-276-8611
Practice Address - Fax:910-276-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36212261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951546Medicaid
NC51546OtherBCBS
NC2210616DMedicare PIN
NC8951546Medicaid