Provider Demographics
NPI:1710352992
Name:DERMONE PLASTIC SURGERY ASSOCIATES OF NORTH CAROLINA, PA
Entity Type:Organization
Organization Name:DERMONE PLASTIC SURGERY ASSOCIATES OF NORTH CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-840-3093
Mailing Address - Street 1:200 BARR HARBOR DRIVE, SUITE 200
Mailing Address - Street 2:FOUR TOWER BRIDGE
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:848-240-2812
Mailing Address - Fax:732-731-6135
Practice Address - Street 1:6752 ROCK SPRING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3179
Practice Address - Country:US
Practice Address - Phone:910-762-1070
Practice Address - Fax:732-731-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty