NPIMap

Organization Active NPI

Easterm Dermatology, PA

  • Dermatology Physician
  • Greenville, NC
National Provider Identifier
1457722043
Registry record updated Oct 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EASTERM DERMATOLOGY, PA
Practice address
420 Spring Forest Rd
Greenville, NC 27834-7244
Phone
(252) 752-4124
Fax
(252) 758-8954
NPI assigned
Oct 8, 2015
Organization subpart
Yes
Parent organization
EASTERN DERMATOLOGY, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 8, 2015

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

Authorized official

Name
Dr. Cameron L Smith, MD
Title
Partner
Phone
(252) 752-4124

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X NC Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X NC

Addresses

Primary practice location

420 Spring Forest Rd
Greenville, NC 27834-7244

Mailing address

1165 Cedar Point Blvd
Suie F
Cedar Point, NC 28584-8023
Phone (252) 764-2986

Other identifiers 2

IdentifierTypeStateIssuer
01498OtherNCBCBS
8901498MedicaidNC

National Provider Directory

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

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1457722043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 CEDAR POINT BLVD",
            "address_2": "SUIE F",
            "city": "CEDAR POINT",
            "state": "NC",
            "postal_code": "285848023",
            "telephone_number": "252-764-2986",
            "fax_number": "252-758-8954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERM DERMATOLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTERN DERMATOLOGY, PA",
        "enumeration_date": "2015-10-08",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "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
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01498",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901498",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; 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.