Provider Demographics
NPI:1942428982
Name:CAROLINA DERMATOLOGY AND SKIN CANCER SURGERY PA
Entity type:Organization
Organization Name:CAROLINA DERMATOLOGY AND SKIN CANCER SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-254-3544
Mailing Address - Street 1:PO BOX 15430
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5430
Mailing Address - Country:US
Mailing Address - Phone:910-793-9545
Mailing Address - Fax:910-397-0366
Practice Address - Street 1:1814 GLEN MEADE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6023
Practice Address - Country:US
Practice Address - Phone:910-254-3544
Practice Address - Fax:910-254-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015VKMedicaid
NC2330983Medicare PIN