Provider Demographics
NPI:1760649545
Name:SEACOAST SKIN SURGERY PLLC
Entity Type:Organization
Organization Name:SEACOAST SKIN SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:VIEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-256-2100
Mailing Address - Street 1:710 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2375
Mailing Address - Country:US
Mailing Address - Phone:910-256-2100
Mailing Address - Fax:
Practice Address - Street 1:710 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2375
Practice Address - Country:US
Practice Address - Phone:910-256-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600763261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG49857Medicare UPIN