Organization
NEW AGE DERMATOLOGY CENTER PA
Active
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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