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Individual

DR. THOMAS J KNACKSTEDT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1006 PROCURE ST STE 100, FUQUAY VARINA, NC 27526-2627
(919) 762-6845
(919) 762-6865
Mailing address
1006 PROCURE ST STE 100, FUQUAY VARINA, NC 27526-2627
(919) 762-6845
(919) 762-6865

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2022-01519
NC
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
2022-01519
NC
207NS0135X
Procedural Dermatology Physician
2022-01519
NC

Other

Enumeration date
06/16/2011
Last updated
07/07/2023
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