Provider Demographics
NPI:1396702619
Name:LASER SKIN CARE PLLC
Entity type:Organization
Organization Name:LASER SKIN CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:HUTCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-867-7212
Mailing Address - Street 1:750 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3481
Mailing Address - Country:US
Mailing Address - Phone:704-867-7212
Mailing Address - Fax:704-867-7655
Practice Address - Street 1:750 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3481
Practice Address - Country:US
Practice Address - Phone:704-867-7212
Practice Address - Fax:704-867-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01616OtherBLUE CROSS PROVIDER #
NC8945146Medicaid
NCC84659Medicare UPIN
207480Medicare ID - Type UnspecifiedPROVIDER NUMBER