Wayne Dermatology and Cosmetic Surgery PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

24161 Issued in NC

Legal business name

WAYNE DERMATOLOGY AND COSMETIC SURGERY PA

Practice address

1100 E Ash Street
Goldsboro, NC 27530-5102

Phone

(919) 734-0944

Fax

(919) 734-1921

NPI assigned

Aug 3, 2006

Organization subpart

No

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

Authorized official

Name

John Haverkamp, MDNPI 1902888670

Title

Owner

Phone

(919) 734-0944

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• John Haverkamp, MD

  • Dermatology Physician
  • Goldsboro, NC
  • NPI 1902888670
  NPD Authorized official
• Joyce S Smith, NP-C

  • Nurse Practitioner
  • Goldsboro, NC
  • NPI 1508985904
  NPD

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332374400000",
    "number": "1396753885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1399",
            "address_2": "1100 E ASH STREET",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275331399",
            "telephone_number": "919-734-0944",
            "fax_number": "919-734-1921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E ASH STREET",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275305102",
            "telephone_number": "919-734-0944",
            "fax_number": "919-734-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE DERMATOLOGY AND COSMETIC SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2012-03-22",
        "status": "A",
        "authorized_official_last_name": "HAVERKAMP",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-734-0944",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NC",
            "license": "24161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902920",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wayne County Family Life Residential Home
• Wayne County Group Homes
• Wayne County Health Department
• Wayne County Health Department
• Wayne County Schools
• Wayne Family Medical Center, Inc.
• Wayne Foot Specialists PC
• Wayne Health Family Medicine LLC
• Wayne Health Foundation (Watch)
• Wayne Health Medical Clinic, LLC

• Dermatology Physician in Goldsboro, NC
• Providers in Goldsboro, 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 Mar 22, 2012; 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.