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WESTGATE DERMATOLOGY AND LASER CENTER P.A. NPI 1821240995


NPI Information

NPI: 1821240995
Provider Name: WESTGATE DERMATOLOGY AND LASER CENTER, P.A.
Classification: Dermatology - 207ND0900X
Entity Type: Organization

Specialization: Dermatopathology

CLIA Number: 34D1094366

Address:
2020 PEACE HAVEN RD
WINSTON SALEM, NC
ZIP 27106
Phone: (336) 768-1280
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WESTGATE DERMATOLOGY AND LASER CENTER, P.A. is a dermatopathology dermatology in Winston Salem, NC. The provider is a dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. WESTGATE DERMATOLOGY AND LASER CENTER, P.A. NPI is 1821240995. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2020 PEACE HAVEN RD
WINSTON SALEM, NC
ZIP 27106-851
Phone: (336) 768-1280

The provider's authorized official is Paul J Kostuchenko .
The authorized official title is President and has the following contact phone number (336) 768-1280.

The CLIA number assigned to this NPI record is 34D1094366 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/21/2008 and was last updated on 10/2/2012.


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
1207ND0900XDermatologyDermatopathologyNORTH 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
1QPB766OTHERNORTH CAROLINASC MEDICAID
2QPB766MEDICAIDSOUTH CAROLINA
35950698MEDICAIDNORTH CAROLINA
42026585BMEDICARE PINNORTH CAROLINA

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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