Provider Demographics
NPI:1700298635
Name:MOUNTAIN LAUREL DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN LAUREL DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-565-0560
Mailing Address - Street 1:PO BOX 1921
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-1900
Mailing Address - Country:US
Mailing Address - Phone:828-565-0560
Mailing Address - Fax:
Practice Address - Street 1:107 HAYWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-4405
Practice Address - Country:US
Practice Address - Phone:828-565-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty