Provider Demographics
NPI:1902869530
Name:CARY SKIN CENTER, PA
Entity Type:Organization
Organization Name:CARY SKIN CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:919-363-7546
Mailing Address - Street 1:200 WELLESLEY TRADE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5576
Mailing Address - Country:US
Mailing Address - Phone:919-363-7546
Mailing Address - Fax:919-363-3616
Practice Address - Street 1:200 WELLESLEY TRADE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5576
Practice Address - Country:US
Practice Address - Phone:919-363-7546
Practice Address - Fax:919-363-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81706207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30557OtherWELLPATH
NC8901603Medicaid
NC01603OtherBCBS
NC=========003OtherCIGNA
NC8901603Medicaid
NC30557OtherWELLPATH