Healthcare Provider Details

I. General information

NPI: 1588674568
Provider Name (Legal Business Name): FLYNN DERMATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 DURALEIGH RD SUITE 111
RALEIGH NC
27612-2688
US

IV. Provider business mailing address

5603 DURALEIGH RD SUITE 111
RALEIGH NC
27612-2688
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-0840
  • Fax: 919-791-0911
Mailing address:
  • Phone: 919-791-0840
  • Fax: 919-791-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNC

VIII. Authorized Official

Name: MATTHEW K FLYNN
Title or Position: PRESIDENT
Credential: MD
Phone: 919-791-0840