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Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2100 ERWIN RD, DURHAM, NC 27710-0001
(919) 684-8111
Mailing address
79 PLEASANT ST, APT. # 3, BROOKLINE, MA 02446-7107
(617) 667-3753

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
223934
MA
207N00000X
Dermatology Physician
Primary
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14608
BCBS PIN
NC
Enumeration date
05/28/2006
Last updated
10/10/2007
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