Basic Information
| Provider Information | |||||||||
| NPI: | 1043274855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASHEVILLE DERMATOLOGY CENTER, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1689 | ||||||||
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| City: | ETOWAH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287291689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288915524 | ||||||||
| FaxNumber: | 8288914069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2161 HENDERSONVILLE RD | ||||||||
| Address2: | STE C | ||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287047741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286841875 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | WESTLY | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8286841875 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 690298U | 05 | NC | MEDICAID |