NPIMap

Organization Active NPI

On Site Dermatology of North Carolina, PLLC

  • Dermatology Physician
  • Raleigh, NC
National Provider Identifier
1376957340
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ON SITE DERMATOLOGY OF NORTH CAROLINA, PLLC
Practice address
3737 Glenwood Ave Ste 100
Raleigh, NC 27612-5515
Phone
(877) 345-5300
NPI assigned
Jun 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

3737 Glenwood Ave Ste 100
Raleigh, NC 27612-5515

Mailing address

4700 Exchange CT Ste 110
Boca Raton, FL 33431-4450
Phone (561) 314-2000

Other practice location 1

100 Hedrick Dr
Thomasville, NC 27360-6009
Phone (877) 345-5300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140915001189 NC Part B Supplier - Clinic/Group Practice 1355560996 Receives reassigned benefits from 6 practitioners

National Provider Directory

National Provider Directory

Locations

2400 Appalachian Blvd
Arden, NC 28704
Phone (828) 231-1001

2360 Sweeten Creek Rd
Asheville, NC 28803
Phone (828) 274-4800

266 Merrimon Ave
Asheville, NC 28801
Phone (828) 253-6712

1617 Hendersonville Rd
Asheville, NC 28803
Phone (828) 274-1531

10820 Penny Rd
Cary, NC 27518
Phone (919) 303-7068

405 Smith Level Rd
Chapel Hill, NC 27516
Phone (919) 926-0244

501 Blakey Hall Ln
Elon College, NC 27244
Phone (336) 506-2310

1911 Orange Grove Rd
Hillsborough, NC 27278
Phone (919) 732-9040

6498 Ray Rd
Raleigh, NC 27613

1580 Dunn Rd
Raleigh, NC 27614

10810 Sandy Oak Ln
Raleigh, NC 27614
Phone (919) 846-7147

3113 Charles B Root Wynd
Raleigh, NC 27612

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1376957340",
    "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": "3737 GLENWOOD AVE STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125515",
            "telephone_number": "877-345-5300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Hedrick Dr",
            "address_purpose": "LOCATION",
            "city": "Thomasville",
            "state": "NC",
            "postal_code": "273606009",
            "country_code": "US",
            "telephone_number": "877-345-5300",
            "fax_number": "561-989-3665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ON SITE DERMATOLOGY OF NORTH CAROLINA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-17",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; 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.