Organization
KINSTON DERMATOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANA MONROE HENSHAW EDD (SECRETARY/TREASURER)
(252) 523-3289
Entity
Organization
Contact information
Practice address
701 DOCTORS DR, KINSTON CLINIC NORTH, SUITE F, KINSTON, NC 28501-1584
(252) 523-3289
(252) 523-1310
Mailing address
701 DOCTORS DR, KINSTON CLINIC NORTH, SUITE F, KINSTON, NC 28501-1584
(252) 523-3289
(252) 523-1310
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
84026
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105H
BCBS
—
05
—
790105H
—
NC
Enumeration date
08/30/2006
Last updated
08/22/2020
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