Provider Demographics
NPI:1104678085
Name:CAROLINA DERMATOLOGY PA
Entity type:Organization
Organization Name:CAROLINA DERMATOLOGY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DARRAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-293-0281
Mailing Address - Street 1:920 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4105
Mailing Address - Country:US
Mailing Address - Phone:864-233-6338
Mailing Address - Fax:864-235-1982
Practice Address - Street 1:920 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4105
Practice Address - Country:US
Practice Address - Phone:864-233-6338
Practice Address - Fax:864-235-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty