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Organization

MOUNTAINVIEW SKIN CARE PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. PAUL WORTMAN M.D. (PRESIDENT, OWNER)
(336) 893-8423
Entity
Organization

Contact information

Practice address
4680 BROWNSBORO RD B, WINSTON SALEM, NC 27106-3428
(336) 893-8423
(336) 893-8426
Mailing address
127 S POPLAR ST, WINSTON SALEM, NC 27101-3755
(336) 893-8423
(336) 893-8426

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
126743
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2346511
MEDICARE PTAN
NC
01
89261
BCBS NC
05
8989261
NC
01
DF5077
RAILROAD MEDICARE
Enumeration date
05/03/2007
Last updated
11/27/2017
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