Provider Demographics
NPI:1205999687
Name:CAROLINA SKIN CARE, PA
Entity type:Organization
Organization Name:CAROLINA SKIN CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:KLUMPAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-295-7546
Mailing Address - Street 1:125 FOX HOLLOW RD
Mailing Address - Street 2:STE 210
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8511
Mailing Address - Country:US
Mailing Address - Phone:910-295-7546
Mailing Address - Fax:910-692-2831
Practice Address - Street 1:125 FOX HOLLOW RD
Practice Address - Street 2:STE 210
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8511
Practice Address - Country:US
Practice Address - Phone:910-295-7546
Practice Address - Fax:910-692-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34653207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0153YOtherBLUECROSSBLUESHIELD
NC8949708Medicaid
NCCE7551OtherRAILROAD MEDICARE
NC1730283276OtherINDIVIDUAL NPI
NCG33351Medicare UPIN
NC2322155Medicare PIN