Sanford Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SANFORD DERMATOLOGY PLLC

Practice address

1911 K M Wicker Memorial Dr
Sanford, NC 27330-5070

Phone

(919) 775-7926

Fax

(919) 718-0092

NPI assigned

Jun 11, 2014

Last updated

Nov 8, 2024By 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

Jeffrey D. Queen

Title

Manager

Phone

(561) 314-2000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 5

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.

• Dawn Elizabeth Kleinman, MD

  • Dermatology Physician
  • Sanford, NC
  • NPI 1629164850
  Medicare reassignment Care Compare group NPD
• John Davidson Cheesborough, MD

  • Dermatology Physician
  • Sanford, NC
  • NPI 1396710380
  Medicare reassignment Care Compare group
• Katherine Serafen Koonce, PA-C

  • Physician Assistant
  • Sanford, NC
  • NPI 1194389353
  Medicare reassignment Care Compare group
• Ian Perkins, PA

  • Physician Assistant
  • Sanford, NC
  • NPI 1154637932
  Medicare reassignment Care Compare group
• Kandice Leigh Phifer

  • Physician Assistant
  • Sanford, NC
  • NPI 1790458982
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1205240868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-314-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 K M WICKER MEMORIAL DR",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273305070",
            "telephone_number": "919-775-7926",
            "fax_number": "919-718-0092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "QUEEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "561-314-2000"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sanford Cardiology, PLLC
• Sanford Care Internal Medicine, P.C.
• Sanford Center for Sleep Disorders, L.L.C.
• Sanford Chemists, Inc. (Medicine Park Pharmacy)
• Sanford Chemists, Inc. (Medicine Park Pharmacy)
• Sanford Dermatology, PA
• Sanford Emergency Group LLC
• Sanford Health and Rehabilitation Co LLC
• Sanford Manor, LLC
• Sanford Medical Group, P.a.

• Dermatology Physician in Sanford, NC
• Providers in Sanford, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; 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.