MEDICARE: ALAMANCE SKIN CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	32755	NC

General Provider Information

NPI Number	:	1366568107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMANCE SKIN CENTER

Provider Business Mailing Address
First Line	:	1734 WESTBROOK AVE
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8721
Country	:	US
Telephone Number	:	336-584-5801
Fax Number	:	336-584-5860

Provider Business Practice Location Address
First Line	:	1734 WESTBROOK AVE
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8721
Country	:	US
Telephone Number	:	336-584-5801
Fax Number	:	336-584-5860

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LISA G JONES
Credential	:
Telephone Number	:	336-584-5801

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	03/19/2008

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Directions to “ALAMANCE SKIN CENTER ” Practice Location

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