Healthcare Provider Details

I. General information

NPI: 1669834057
Provider Name (Legal Business Name): MEGHAN ANN SKOTNICKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 N CHURCH ST STE 200
GREENSBORO NC
27401-1040
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-379-9445
  • Fax: 336-544-7180
Mailing address:
  • Phone: 336-716-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2021-01668
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: