Provider Demographics
NPI:1649232687
Name:DURHAM DERMATOLOGY
Entity Type:Organization
Organization Name:DURHAM DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARCHASE
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-220-8300
Mailing Address - Street 1:2609 N DUKE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3048
Mailing Address - Country:US
Mailing Address - Phone:919-220-8300
Mailing Address - Fax:919-220-5805
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3048
Practice Address - Country:US
Practice Address - Phone:919-220-8300
Practice Address - Fax:919-220-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0174TOtherBCBS OF NORTH CAROLINA
NC790174TMedicaid
NC790174TMedicaid