| Maryanna C Ter Poorten, MD | |
|
335 Penny Ln, Concord, NC 28025-1221 | |
| (704) 784-5901 | |
| (704) 721-0413 |
| Full Name | Maryanna C Ter Poorten |
|---|---|
| Gender | Female |
| Speciality | Dermatology - Procedural Dermatology |
| Location | 335 Penny Ln, Concord, North Carolina |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477539724 | NPI | - | NPPES |
| 89134VK | Medicaid | NC | |
| P00232695 | Other | NC | MEDICARE RAILROAD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207NS0135X | Dermatology - Procedural Dermatology | 2003-00893 (North Carolina) | Primary |
| Entity Name | Dermatology Group Of The Carolinas |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1437110772 PECOS PAC ID: 3678514759 Enrollment ID: O20050518001227 |
| Mailing Address | Practice Location Address |
|---|---|
| Maryanna C Ter Poorten, MD 335 Penny Ln, Concord, NC 28025-1221 Ph: (704) 784-5901 | Maryanna C Ter Poorten, MD 335 Penny Ln, Concord, NC 28025-1221 Ph: (704) 784-5901 |
Brian Scott Walther, D.O. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 335 Penny Ln, Concord, NC 28025 Phone: 704-784-5901 Fax: 704-721-0413 | |
Mr. Aaron Sidscott Wever, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 335 Penny Ln, Concord, NC 28025 Phone: 704-784-5901 Fax: 704-721-0413 | |
Katherine Stiff, Dermatology Medicare: Medicare Enrolled Practice Location: 335 Penny Ln, Concord, NC 28025 Phone: 704-784-5901 | |
Dr. William Elliot Love, D.O. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 335 Penny Ln, Concord, NC 28025 Phone: 704-784-5901 | |
Joseph J Roche, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 335 Penny Ln, Concord, NC 28025 Phone: 704-784-5901 Fax: 704-721-0413 | |
Dr. Nathaniel Allen Slater, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 335 Penny Ln, Concord, NC 28025 Phone: 704-784-5901 |