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General NPI Number Information
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NPI Number | 1205242252
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Entity Type | Organization
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Legal Business Name | MIDTOWN DERMATOLOGY, PC
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 5904 SIX FORKS RD STE 211
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City | RALEIGH
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State | NC
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Zip | 27609-8228
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Country | US
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Telephone | 984-242-0510
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Fax | 984-242-0520
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Provider Business Mailing Address
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Address Line | 5904 SIX FORKS RD STE 211
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City | RALEIGH
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State | NC
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Zip | 27609-8228
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Country | US
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Telephone | 984-242-0510
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Fax | 984-242-0520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETH ANNE SCHULZ-BUTULIS
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Credential | DO
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Telephone | 984-242-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 203528
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License Number State | NC
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