NPIMap

Organization Active NPI

Eastern Dermatology, PA

  • Dermatology Physician
  • Morehead City, NC
National Provider Identifier
1356576417
Registry record updated Aug 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EASTERN DERMATOLOGY, PA
Practice address
4251 Arendell St
Suite a
Morehead City, NC 28557-2805
Phone
(252) 752-4124
Fax
(252) 758-8954
NPI assigned
May 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2011

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

Authorized official

Name
Dr. Cameron Langley Smith, MD
Title
President
Phone
(252) 752-4124

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X NC Primary

Addresses

Primary practice location

4251 Arendell St
Suite a
Morehead City, NC 28557-2805

Mailing address

420 Spring Forest Rd
Greenville, NC 27834-7244
Phone (252) 752-4124

Other identifiers 3

IdentifierTypeStateIssuer
01498OtherNCBCBSNC
8901498MedicaidNC
230298OtherNCMEDICARE GROUP NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Eastern Dermatology P6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313971200000",
    "number": "1356576417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SPRING FOREST RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347244",
            "telephone_number": "252-752-4124",
            "fax_number": "252-758-8954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4251 ARENDELL ST",
            "address_2": "SUITE A",
            "city": "MOREHEAD CITY",
            "state": "NC",
            "postal_code": "285572805",
            "telephone_number": "252-752-4124",
            "fax_number": "252-758-8954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-19",
        "last_updated": "2011-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "LANGLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-752-4124",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "01498",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901498",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "230298",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morehead City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.