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General NPI Number Information
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NPI Number | 1770545550
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE DERMATOLOGY ASSOCIATES
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 4225 MACON POND RD STE 300
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City | RALEIGH
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State | NC
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Zip | 27607-6320
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Country | US
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Telephone | 919-781-1050
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Fax | 919-510-5090
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Provider Business Mailing Address
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Address Line | 4225 MACON POND RD STE 300
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City | RALEIGH
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State | NC
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Zip | 27607-6320
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Country | US
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Telephone | 919-781-1050
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Fax | 919-510-5090
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | LYNDA A AMSDEN
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Credential |
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Telephone | 919-781-1050
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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 |
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