Provider Demographics
NPI:1265530091
Name:SKINNER, DIRK E (MD)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:E
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 E CHESTNUT AVE
Mailing Address - Street 2:BUILDING 7B
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5053
Mailing Address - Country:US
Mailing Address - Phone:856-691-8383
Mailing Address - Fax:856-691-9505
Practice Address - Street 1:1138 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 7B
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5053
Practice Address - Country:US
Practice Address - Phone:856-691-8383
Practice Address - Fax:856-691-9505
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA416432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2486407Medicaid
NJC53312Medicare UPIN
NJ2486407Medicaid