=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588641724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN RUTH SKARDA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 01/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 TAYLOR NOTION RD SUITE E
-----------------------------------------------------
City | CAPE CARTERET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28584-8944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-354-1970
-----------------------------------------------------
Fax | 252-354-1968
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3608 MEDICAL PARK CT
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-4347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-354-1970
-----------------------------------------------------
Fax | 252-354-1968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 36431
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------