Organization
LAKESIDE DERMATOLOGY , PA
Active
Organization
LAKESIDE DERMATOLOGY , PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY J ASTLE MD (PRESIDENT/PHYSICIAN)
(704) 892-4878
Entity
Organization
Contact information
Practice address
19900 W CATAWBA AVE, SUITE B, CORNELIUS, NC 28031-4032
(704) 892-4878
(704) 892-7453
Mailing address
19900 W CATAWBA AVE, STE B, CORNELIUS, NC 28031-4032
(704) 892-4878
(704) 892-7453
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9400198
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01056
BCBS
NC
01
—
CA0767
RAILROAD MEDICARE
—
01
—
E82914
UPIN
—
Enumeration date
06/21/2005
Last updated
03/23/2011
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