Healthcare Provider Details

I. General information

NPI: 1700298635
Provider Name (Legal Business Name): MOUNTAIN LAUREL DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FALCON CREST LN
CLYDE NC
28721-6620
US

IV. Provider business mailing address

PO BOX 1921
CLYDE NC
28721-1900
US

V. Phone/Fax

Practice location:
  • Phone: 828-565-0560
  • Fax:
Mailing address:
  • Phone: 828-565-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. GINA R SINGLETON
Title or Position: MANAGING PHYSICIAN
Credential: M.D.
Phone: 828-565-0560