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BEAVERS DERMATOLOGY & SKIN SURGERY PLLC NPI 1477842573


NPI Information

NPI: 1477842573
Provider Name: BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 34D2022070

Address:
207 E MEADOW RD STE 1
EDEN, NC
ZIP 27288
Phone: (336) 627-3194
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BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC is a dermatology in Eden, NC. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC NPI is 1477842573. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

207 E MEADOW RD STE 1
EDEN, NC
ZIP 27288-469
Phone: (336) 627-3194
Fax: (336) 627-3208

The provider's authorized official is Clarence Beavers .
The authorized official title is Owner and has the following contact phone number (336) 627-3194.

The CLIA number assigned to this NPI record is 34D2022070 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/30/2011 and was last updated on 10/22/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatology39543NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15917187MEDICAIDNORTH CAROLINA
2DR4608OTHERNORTH CAROLINARAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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