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General NPI Number Information
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NPI Number | 1295930865
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Entity Type | Organization
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Legal Business Name | THE DERMATOLOGY CENTER OF RALEIGH
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 9104 FALLS OF NEUSE RD STE 310
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City | RALEIGH
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State | NC
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Zip | 27615-2498
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Country | US
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Telephone | 919-645-1090
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Fax | 888-971-3717
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Provider Business Mailing Address
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Address Line | 9104 FALLS OF NEUSE RD STE 310
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City | RALEIGH
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State | NC
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Zip | 27615-2498
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Country | US
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Telephone | 919-645-1090
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Fax | 919-585-9445
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CAROL A. TRAKIMAS
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Credential | D.O.
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Telephone | 919-573-9030
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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 | 200100287
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License Number State | NC
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