Basic Information
| Provider Information | |||||||||
| NPI: | 1558314369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKINNER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | NAISANG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 75216 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282750216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367187080 | ||||||||
| FaxNumber: | 3367189622 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 SILAS CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362778800 | ||||||||
| FaxNumber: | 3362778850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 200300886 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1558314369 | 05 | VA | MEDICAID | 189421 | 01 | NC | MEDCOST | OTHER | 5903761 | 05 | NC | MEDICAID | 13411 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 2365784 | 01 | NC | UNITED HEALTHCARE | OTHER | 7296451 | 01 | AETNA US HEALTHCARE | OTHER | P00270693 | 01 | RAILROAD MEDICARE | OTHER | 803406 | 01 | NC | PARTNERS NATIONAL HEALTH | OTHER | 1783167 | 01 | CIGNA HEALTHCARE | OTHER | 010268982 | 05 | VA | MEDICAID |