Organization
PINEHURST DERMATOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE F MILLENBAUGH (OFFICE MANAGER)
(910) 295-8748
Entity
Organization
Contact information
Practice address
120 BRAEMAR CT, PINEHURST, NC 28374-8747
(910) 295-5567
(910) 295-3315
Mailing address
120 BRAEMAR CT, PINEHURST, NC 28374-8747
(910) 295-5567
(910) 295-3315
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02423
BLUE CROSS
NC
05
—
8902423
—
NC
Enumeration date
09/13/2006
Last updated
07/14/2020
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