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General NPI Number Information
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NPI Number | 1962544767
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Entity Type | Organization
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Legal Business Name | BURLINGTON DERMATOLOGY CENTER, INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 1522 VAUGHN RD
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City | BURLINGTON
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State | NC
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Zip | 27217-2871
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Country | US
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Telephone | 336-226-9393
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Fax | 336-227-0496
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Provider Business Mailing Address
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Address Line | 1522 VAUGHN RD
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City | BURLINGTON
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State | NC
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Zip | 27217-2871
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Country | US
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Telephone | 336-226-9393
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Fax | 336-227-0496
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RICHARD ROBERT HENDERSON
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Credential | M.D.
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Telephone | 336-226-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13641
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License Number State | NC
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