Island Park Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ISLAND PARK DERMATOLOGY LLC

Practice address

109 River Landing Dr Ste 400
Daniel Island, SC 29492-7300

Phone

(843) 469-5641

NPI assigned

Dec 12, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Cynthia Irby Wilson, MDNPI 1003077363

Title

Owner

Phone

(843) 469-5641

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

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

• Cynthia Irby Wilson, M.D.

  • Dermatology Physician
  • Charleston, SC
  • NPI 1003077363
  Medicare reassignment Care Compare group NPD Authorized official
• Heather L. Wolf, P.A.

  • Medical Physician Assistant
  • Daniel Island, SC
  • NPI 1801824511
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1670803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1194436956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 RIVER LANDING DR STE 400",
            "city": "DANIEL ISLAND",
            "state": "SC",
            "postal_code": "294927300",
            "telephone_number": "843-469-5641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 RIVER LANDING DR STE 400",
            "city": "DANIEL ISLAND",
            "state": "SC",
            "postal_code": "294927300",
            "telephone_number": "843-469-5641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND PARK DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-12",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "IRBY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-469-5641",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucy Lee Hoskins, MS, CCC-SLP
• Stacey Williams Howell, P.T.A., A.T.C.
• Jessica Hund, M.D.
• John Gardner Inman, MD
• Island Eye Care
• J. Suzanne Cherry, PT
• Kimberly Shelley Jackson, M.D.
• Elizabeth Marie Jantz, DDS
• Alex Johnson, PTA
• Dana Wright Johnson, RPH

• Dermatology Physician in Daniel Island, SC
• Providers in Daniel Island, SC by specialty
• Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; 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.