Provider Demographics
NPI:1811428626
Name:UNC AESTHETIC, LASER, AND BURN CENTER
Entity type:Organization
Organization Name:UNC AESTHETIC, LASER, AND BURN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-974-1273
Mailing Address - Street 1:211 FRIDAY CENTER DR
Mailing Address - Street 2:STE 2066
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9499
Mailing Address - Country:US
Mailing Address - Phone:984-974-1273
Mailing Address - Fax:
Practice Address - Street 1:151 OLD UNIVERSITY STATION RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1935
Practice Address - Country:US
Practice Address - Phone:984-974-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty