Polley Clinic of Dermatology & Dermatologic Surgery

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

27881 Issued in NC

Legal business name

POLLEY CLINIC OF DERMATOLOGY & DERMATOLOGIC SURGERY

Practice address

1806 Glendale Dr SW
Wilson, NC 27893-4402

Phone

(252) 243-0566

Fax

(252) 243-1347

NPI assigned

Jul 21, 2006

Last updated

Aug 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelli Newman

Title

Credentialing Specialist

Phone

(252) 668-7026

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Lynn Cavanagh, MSN, FNP

  • Family Nurse Practitioner
  • Smithfield, NC
  • NPI 1902856776
  Medicare reassignment Care Compare group NPD
• Dennis Polley, D.O.

  • Dermatology Physician
  • Wilson, NC
  • NPI 1649291394
  Medicare reassignment Care Compare group NPD
• Hannah Marie Downing, PA-C

  • Physician Assistant
  • Goldsboro, NC
  • NPI 1396411898
  Medicare reassignment Care Compare group
• Ryan Lloyd Hoover, PA-C

  • Physician Assistant
  • Goldsboro, NC
  • NPI 1548511207
  Medicare reassignment Care Compare group
• Courtney Lee Littere, PA-C

  • Physician Assistant
  • Wilson, NC
  • NPI 1992378251
  Medicare reassignment Care Compare group
• Cassie McGee

  • Physician Assistant
  • Wilson, NC
  • NPI 1992165104
  Medicare reassignment Care Compare group
• Dennis Polley II, PA-C

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1093161440
  Medicare reassignment Care Compare group
• Mohammed Saeb Shakir

  • Physician Assistant
  • Fayetteville, NC
  • NPI 1851895924
  Medicare reassignment Care Compare group
• Joseph Michael Wilkinson, FNP-BC

  • Nurse Practitioner
  • Smithfield, NC
  • NPI 1588685937
  Medicare reassignment Care Compare group
• Frank Joseph Ferritto, PA-C

  • Physician Assistant
  • Knightdale, NC
  • NPI 1295780849
  Medicare reassignment
• Ronald F Marascalco, PA-C

  • Physician Assistant
  • Wilson, NC
  • NPI 1649389651
  Medicare reassignment
• Michael E. Sabol, PA-C

  • Physician Assistant
  • Hickory, NC
  • NPI 1326135872
  Medicare reassignment

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1104847714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 GLENDALE DR SW",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934402",
            "telephone_number": "252-243-0566",
            "fax_number": "252-243-1347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 GLENDALE DR SW",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934402",
            "telephone_number": "252-243-0566",
            "fax_number": "252-243-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLLEY CLINIC OF DERMATOLOGY & DERMATOLOGIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2021-08-04",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "252-668-7026"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "NC",
            "license": "27881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pierre a Lemaire MD PA
• James L. Pita
• Greta Vanbree Pittman
• Kimberly Bridgers Pittman
• Playful Pathways Learning & Development, LLC
• Dennis Polley, D.O.
• Elizabeth Pollock, MS, LCMHCA
• Alice Hall Pope
• Port Human Services
• Positive Life Styles

• Dermatopathology Physician in Wilson, NC
• Providers in Wilson, NC by specialty
• Dermatopathology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.