1558314369 NPI number — ELIZABETH NAISANG SKINNER MD

Table of content: DOROTHY JEAN SURFACE (NPI 1457237497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558314369 NPI number — ELIZABETH NAISANG SKINNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKINNER
Provider First Name:
ELIZABETH
Provider Middle Name:
NAISANG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558314369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 75216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28275-0216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-718-7080
Provider Business Mailing Address Fax Number:
336-718-9622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 SILAS CREEK PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-277-8800
Provider Business Practice Location Address Fax Number:
336-277-8850
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0201X , with the licence number:  200300886 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1558314369 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189421 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5903761 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13411 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2365784 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7296451 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00270693 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803406 . This is a "PARTNERS NATIONAL HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1783167 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010268982 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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