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NPI Code Detail

MEDICARE: LOWER CAPE FEAR DERMATOLOGY CLINIC, P.A.

MEDICARE: LOWER CAPE FEAR DERMATOLOGY CLINIC, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist103912NC

General Provider Information

NPI Number : 1770509358
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOWER CAPE FEAR DERMATOLOGY CLINIC, P.A.
Provider Business Mailing Address
First Line : 3904 OLEANDER DR
Second Line : SUITE 102
City : WILMINGTON
State : NC
Zip : 28403-6717
Country : US
Telephone Number : 910-452-0400
Fax Number : 910-452-0355
Provider Business Practice Location Address
First Line : 3904 OLEANDER DR
Second Line : SUITE 102
City : WILMINGTON
State : NC
Zip : 28403-6717
Country : US
Telephone Number : 910-452-0400
Fax Number : 910-452-0355
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : MRS. MARYLOU COURREGE
Credential : M.D.
Telephone Number : 910-452-0400
Provider Enumeration Date : 07/15/2006
Last Update Date : 03/30/2009

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1952589780 — JULIE ANNMARIE MILLER MSW, LCSW
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Practice Fax: 910-796-8111

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