PAUL J KOSTUCHENKO (NPI# 1972591055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972591055 |
| Entity Type | Individual |
| Full Name | PAUL J KOSTUCHENKO |
| Credential | MD |
| Practice Address |
1345 Westgate Center Dr Ste B Winston Salem NC 27103-3041 |
| Mailing Address |
1351-b Westgate Center Dr Winston-salem NC 27103-3041 |
| Practice Telephone | 3367681280 |
| Practice Fax Number | 3367608443 |
| Mailing Telephone | 3367681280 |
| Mailing Fax Number | 3367608444 |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2009-04-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0900X |
Dermatology Specialization: Dermatopathology |
200400056 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89136R2 | 05 | |
| SC | Q0005F | 05 |
| Street Address |
1345 WESTGATE CENTER DR STE B |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-3041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184190266 | Emily Tierney | Orthotist | 1345 Westgate Center Dr Ste B, Winston Salem, NC 27103-3041 | 2018-10-16 |
| 1497158554 | Tierney Orthotics and Prosthetics Inc. | Prosthetist | 1345 Westgate Center Dr Ste B, Winston Salem, NC 27103-3041 | 2014-10-03 |
| 1912289216 | Cynthia Tierney | Orthotist | 1345 Westgate Center Dr Ste B, Winston Salem, NC 27103-3041 | 2011-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 207ND0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Dermatopathology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821240995 | Westgate Dermatology and Laser Center, P.a. | Dermatology | 2020 Peace Haven Rd, Winston Salem, NC 27106-4851 | 2008-10-21 |
| 1255316311 | Rita O Pichardo-geisinger | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073667077 | Earl George Gross | Dermatology | 3610 Medical Park Court, Morehead City, NC 28557 | 2007-01-23 |
| 1588959894 | Dana Haydel | Dermatology | 706 Green Valley Rd Ste 104, Greensboro, NC 27408 | 2011-06-14 |
| 1841344843 | Crystal Coast Dermatology Services, Pa | Dermatology | 3610 Medical Park Court, Morehead City, NC 28557 | 2007-01-23 |
| 1609961853 | Scott David Mcclellan | Dermatology | 2115 Neuse Blvd, New Bern, NC 28560-4309 | 2006-10-04 |
| 1962411017 | Hee Kim Park | Dermatology | 420 Spring Forest Rd, Greenville, NC 27834-7244 | 2006-08-07 |
| 1104847714 | Polley Clinic of Dermatology & Dermatologic Surgery | Dermatology | 1806 Glendale Dr Sw, Wilson, NC 27893-4402 | 2006-07-21 |
| 1619903176 | Dermatology Associates of Coastal Carolina, Pa | Dermatology | 2115 Neuse Blvd, New Bern, NC 28560-4309 | 2006-06-24 |
| City | WINSTON SALEM |
| Zip Code | 27103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.