NPIMap

Organization Active NPI

Center for Dermatology & Skin Care, Inc.

  • Dermatology Physician
  • South Charleston, WV
National Provider Identifier
1356424667
Registry record updated Jan 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
1300 Issued in WV
Legal business name
CENTER FOR DERMATOLOGY & SKIN CARE, INC.
Practice address
607 Chestnut Street
South Charleston, WV 25309-1205
Phone
(304) 766-9136
Fax
(304) 766-9139
NPI assigned
Oct 23, 2006
Last updated
Jan 27, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2011

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

Authorized official

Name
Dr. Gregory T. Lagos, DONPI 1316946825
Title
President
Phone
(304) 766-9136

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 1300 WV Primary

Addresses

Primary practice location

607 Chestnut Street
South Charleston, WV 25309-1205

Mailing address

607 Chestnut Street
South Charleston, WV 25309-1205
Phone (304) 766-9136

Other identifiers 1

IdentifierTypeStateIssuer
0043648000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050915000363 WV Part B Supplier - Clinic/Group Practice 3971536400 Receives reassigned benefits from 4 practitioners
Practice locations: South Charleston, WV

National Provider Directory

National Provider Directory

Locations

607 Chestnut St
South Charleston, WV 25309
Phone (304) 766-9136

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1356424667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 CHESTNUT STREET",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091205",
            "telephone_number": "304-766-9136",
            "fax_number": "304-766-9139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 CHESTNUT STREET",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091205",
            "telephone_number": "304-766-9136",
            "fax_number": "304-766-9139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR DERMATOLOGY & SKIN CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "LAGOS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-766-9136",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WV",
            "license": "1300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0043648000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; 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.