Healthcare Provider Details

I. General information

NPI: 1649237082
Provider Name (Legal Business Name): SKIN SURGERY CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 PROFESSIONAL PARK DR SUITE 150
WINSTON SALEM NC
27103-1300
US

IV. Provider business mailing address

1450 PROFESSIONAL PARK DR SUITE 150
WINSTON SALEM NC
27103-1300
US

V. Phone/Fax

Practice location:
  • Phone: 336-724-2434
  • Fax: 336-724-6123
Mailing address:
  • Phone: 336-724-2434
  • Fax: 336-724-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BARRY LESHIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 336-724-2434