Active NPI
Fernando R Puente, MD
- MOHS-Micrographic Surgery Physician
- Raleigh, NC
National Provider Identifier
1598741894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- MOHS-Micrographic Surgery Physician
- License
- 39984
- Practice address
- 800 Springfield Commons Dr
Suite 115
Raleigh, NC 27609-8533 - Phone
- (919) 876-3656
- Fax
- (919) 876-2351
- NPI assigned
- Dec 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 39984 | NC | |
| MOHS-Micrographic Surgery Physician | 207ND0101X | 39984 | NC | Primary |
Addresses
Primary practice location
800 Springfield Commons Dr
Suite 115
Raleigh, NC 27609-8533
Mailing address
800 Springfield Commons Dr
Suite 115
Raleigh, NC 27609-8533
Phone (919) 876-3656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39984 | NC | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anne Arundel Dermatology Affiliates PC | Dermatology | Past | Accepting new patients |
Interoperability endpoints
- fernandopuente@rd.allscriptsdirect.net
- fernando.puente.1@18383.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dermatology Physician
- Hunt Valley, MD
- NPI 1083200794
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1598741894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 SPRINGFIELD COMMONS DR",
"address_2": "SUITE 115",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276098533",
"telephone_number": "919-876-3656",
"fax_number": "919-876-2351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 SPRINGFIELD COMMONS DR",
"address_2": "SUITE 115",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276098533",
"telephone_number": "919-876-3656",
"fax_number": "919-876-2351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUENTE",
"first_name": "FERNANDO",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-19",
"last_updated": "2020-10-05",
"certification_date": "2020-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NC",
"license": "39984",
"primary": false
},
{
"code": "207ND0101X",
"taxonomy_group": "",
"desc": "Dermatology, MOHS-Micrographic Surgery",
"state": "NC",
"license": "39984",
"primary": true
}
],
"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 Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.