Provider Demographics
NPI:1750537858
Name:WILMINGTON DERMATOLOGY CENTER, PLLC
Entity type:Organization
Organization Name:WILMINGTON DERMATOLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-256-4350
Mailing Address - Street 1:710 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2375
Mailing Address - Country:US
Mailing Address - Phone:910-256-3450
Mailing Address - Fax:910-239-5032
Practice Address - Street 1:710 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 320
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2375
Practice Address - Country:US
Practice Address - Phone:910-256-3450
Practice Address - Fax:910-239-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00054207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639391931OtherPERSONAL PHYSICIAN NPI