Organization
NEW AGE DERMATOLOGY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICSUNICA ELVIRA CHIRITESCU MD (PHYSICIAN OWNER)
(919) 624-2802
Entity
Organization
Contact information
Practice address
1091 PEMBERTON HILL RD STE 201, APEX, NC 27502-4269
(919) 367-3625
(919) 367-3608
Mailing address
1091 PEMBERTON HILL RD STE 201, APEX, NC 27502-4269
(919) 367-3625
(919) 367-3608
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2000-00747
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
129ER
BLUE CROSS BLUE SHEILD
NC
05
—
89129ER
—
NC
Enumeration date
01/16/2007
Last updated
10/29/2014
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