Dermatology Associates of Coastal Carolina

Primary specialty

Clinical & Laboratory Dermatological Immunology PhysicianTaxonomy code 207NI0002X

Legal business name

DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA

Practice address

3332 Bridges St
Suite B
Morehead City, NC 28557-3280

Phone

(252) 633-4461

Fax

(252) 633-6016

NPI assigned

Feb 25, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Polo, M.D.NPI 1093731168

Title

President/Owner

Phone

(252) 633-4461

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Dermatology Associates of Coastal Carolina

  • Clinical & Laboratory Dermatological Immunology Physician
  • Jacksonville, NC
  • NPI 1033459011

  O20060828000107

  Same enrollment
• Dermatology Associates of Coastal Carolina P.a.

  • Dermatology Physician
  • Kinston, NC
  • NPI 1235405960

  O20060828000107

  Same enrollment
• Dermatology Associates of Coastal Carolina, PA

  • Dermatopathology Physician
  • New Bern, NC
  • NPI 1619903176

  O20060828000107

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James M Polo, M.D.

  • Dermatology Physician
  • New Bern, NC
  • NPI 1093731168
  NPD Authorized official
• Thomas Russell Evans, DO

  • Dermatology Physician
  • Medford, OR
  • NPI 1568757086

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1023358231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 890283",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282890283",
            "telephone_number": "252-633-4461",
            "fax_number": "252-633-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3332 BRIDGES ST",
            "address_2": "SUITE B",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285573280",
            "telephone_number": "252-633-4461",
            "fax_number": "252-633-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "POLO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "252-633-4461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian P. Deal
• Tiffaney Marie Delaney, PHARMD
• Joseph C Dell'Aria, MD
• Mark A Demoranville Jr.
• Kent Denton Jr.
• Anneliese Marie Deussing, RN
• Diabetes & Endocrinology
• Diabetes Care & Education Inc
• Diabetes Care & Education, Inc
• Taylor Dickinson

• Clinical & Laboratory Dermatological Immunology Physician in Morehead City, NC
• Providers in Morehead City, NC by specialty
• Clinical & Laboratory Dermatological Immunology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.