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General NPI Number Information
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NPI Number | 1700298635
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Entity Type | Organization
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Legal Business Name | MOUNTAIN LAUREL DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 11 FALCON CREST LN
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City | CLYDE
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State | NC
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Zip | 28721-6620
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Country | US
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Telephone | 828-565-0560
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1921
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City | CLYDE
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State | NC
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Zip | 28721-1900
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Country | US
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Telephone | 828-565-0560
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Fax |
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. GINA R SINGLETON
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Credential | M.D.
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Telephone | 828-565-0560
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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 |
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License Number State | NC
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