Provider Demographics
NPI:1780261669
Name:RALEIGH SKIN SURGERY CENTER
Entity type:Organization
Organization Name:RALEIGH SKIN SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-390-0210
Mailing Address - Street 1:3200 BLUE RIDGE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8087
Mailing Address - Country:US
Mailing Address - Phone:919-439-1901
Mailing Address - Fax:919-439-1906
Practice Address - Street 1:3200 BLUE RIDGE RD STE 118
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8087
Practice Address - Country:US
Practice Address - Phone:919-439-1901
Practice Address - Fax:919-439-1906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RALEIGH SKIN SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020HYOtherBCBSNC PPN