Organization
SUMMIT COSMETIC SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM NORIN (PRACTICE ADMINISTRATOR)
(910) 794-5355
Entity
Organization
Contact information
Practice address
1717 SHIPYARD BLVD, SUITE 100, WILMINGTON, NC 28403-8023
(910) 794-5355
(910) 794-5358
Mailing address
1717 SHIPYARD BLVD, SUITE 100, WILMINGTON, NC 28403-8023
(910) 794-5355
(910) 794-5358
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9600699
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2344578
PTAN
NC
05
—
89016GK
—
NC
01
—
CH0945
RAILROAD MEDICARE PTAN
NC
Enumeration date
01/26/2016
Last updated
01/26/2016
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