Provider Demographics
NPI:1750046942
Name:OAK CITY DERMATOLOGY
Entity type:Organization
Organization Name:OAK CITY DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-283-1099
Mailing Address - Street 1:115 KILDAIRE PARK DR STE 406
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8130
Mailing Address - Country:US
Mailing Address - Phone:919-283-1099
Mailing Address - Fax:984-220-9248
Practice Address - Street 1:115 KILDAIRE PARK DR STE 406
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8130
Practice Address - Country:US
Practice Address - Phone:919-283-1099
Practice Address - Fax:984-220-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty