Southern Dermatology, P.a.

Primary specialty

SpecialistTaxonomy code 174400000X

License

9900389 Issued in NC

Legal business name

SOUTHERN DERMATOLOGY, P.A.

Practice address

4201 Lake Boone TRL
Suite 200
Raleigh, NC 27607-7511

Phone

(919) 782-2152

Fax

(919) 782-7929

NPI assigned

May 19, 2006

Last updated

Feb 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angela Ruth Peterman

Title

MD

Phone

(443) 351-3376

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 84

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rene Bermudez, DO

  • MOHS-Micrographic Surgery Physician
  • Whiteville, NC
  • NPI 1003895004
  Medicare reassignment Care Compare group NPD
• April Atkins Boswell, MD

  • Dermatology Physician
  • Charlotte, NC
  • NPI 1992927305
  Medicare reassignment Care Compare group NPD
• Margaret B Boyse, M.D.

  • Dermatology Physician
  • Raleigh, NC
  • NPI 1992750319
  Medicare reassignment Care Compare group NPD
• Laura Dennison Briley, MD

  • Dermatology Physician
  • Raleigh, NC
  • NPI 1891994554
  Medicare reassignment Care Compare group NPD
• Eric D Challgren, M.D.

  • MOHS-Micrographic Surgery Physician
  • Raleigh, NC
  • NPI 1477508893
  Medicare reassignment Care Compare group NPD
• Lisa Abernethy Christman, M.D.

  • Dermatology Physician
  • Raleigh, NC
  • NPI 1144214487
  Medicare reassignment Care Compare group NPD
• Christopher Cook, D.O.

  • Dermatology Physician
  • Wilmington, NC
  • NPI 1780999805
  Medicare reassignment Care Compare group NPD
• Jonathan Stuart Crane, D.O.

  • Dermatology Physician
  • Wilmington, NC
  • NPI 1134187594
  Medicare reassignment Care Compare group NPD
• Audrey F Echt, M.D.

  • MOHS-Micrographic Surgery Physician
  • Raleigh, NC
  • NPI 1134123847
  Medicare reassignment Care Compare group NPD
• Andrew Jafar Ghassemian

  • Dermatology Physician
  • Raleigh, NC
  • NPI 1760687370
  Medicare reassignment Care Compare group NPD
• Abigail Leigh Hunter

  • Dermatology Physician
  • Shallotte, NC
  • NPI 1194344994
  Medicare reassignment Care Compare group NPD
• William Stewart Ketcham, M.D.

  • MOHS-Micrographic Surgery Physician
  • Garner, NC
  • NPI 1093866006

  Specialist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1568415586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 CONCOURSE DR STE 201",
            "city": "LINTHICUM HEIGHTS",
            "state": "MD",
            "postal_code": "210901033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 LAKE BOONE TRL",
            "address_2": "SUITE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077511",
            "telephone_number": "919-782-2152",
            "fax_number": "919-782-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A",
        "authorized_official_last_name": "PETERMAN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "443-351-3376"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "9900389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeastern Orthopedics Sports Medicine & Shoulder Center PA
• Southeastern Residential Services of NC
• Southeastern Wake Adult Day Center
• Southeastern Wake Adult Day Center (Southeastern Adult Day Center)
• Southeastern Wake Adult Day Center
• Southern Eye Associates, PA
• Southern Eye Associates, PA
• Southern Home Care Services, Inc
• Southern Home Care Services, Inc. (Rescare Homecare)
• Southern Medical Supply Co

• Specialist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.