Edward Ernest Dickerson, IV, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

9400044 Issued in NC

Practice address

2053 Valleygate Dr Ste 102
Fayetteville, NC 28304-3983

Phone

(910) 323-9222

NPI assigned

Jan 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: edickerson@directaddress.net

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1376514521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2814",
            "city": "BRYSON CITY",
            "state": "NC",
            "postal_code": "287132814",
            "telephone_number": "910-239-7600",
            "fax_number": "828-538-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2053 VALLEYGATE DR STE 102",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043983",
            "telephone_number": "910-323-9222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8510 Colonnade Center Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276155862",
            "country_code": "US",
            "telephone_number": "919-391-3750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON, IV",
        "first_name": "EDWARD",
        "middle_name": "ERNEST",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NC",
            "license": "9400044",
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "NC",
            "license": "94-00044",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "9400044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89129FP",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Ann Dibbins-Boshers
• Craig Michael Dibiase, PT
• Quincy Dickens
• Nichelle Dicker
• Andrea Karen Dickerson, MD
• Glorygrace Dickinson
• Catherine Diehl, RN, BSN, IBCLC
• Lauren Diehl, PA-C
• Jillian Diffenbaugh, LMBT, MBA
• Digestive Health Endoscopy Center (All-American Anesthesia, LLC)

• Otolaryngology Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Otolaryngology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.