Provider Demographics
NPI:1649237082
Name:SKIN SURGERY CENTER PA
Entity Type:Organization
Organization Name:SKIN SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-724-2434
Mailing Address - Street 1:1450 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1300
Mailing Address - Country:US
Mailing Address - Phone:336-724-2434
Mailing Address - Fax:336-724-6123
Practice Address - Street 1:1450 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1300
Practice Address - Country:US
Practice Address - Phone:336-724-2434
Practice Address - Fax:336-724-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011WPMedicaid
NC7110186OtherAETNA
NCF309OtherBLUE MEDICARE
CH4494OtherRAILROAD MEDICARE
NC011WPOtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA
NC7110186OtherAETNA