Carolina Dermatology Clinic, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

24039 Issued in SC

Legal business name

CAROLINA DERMATOLOGY CLINIC, PA

Practice address

933 Saint Andrews Blvd
Charleston, SC 29407

Phone

(843) 766-9868

Fax

(843) 571-4925

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Edward A. Kotz III, MDNPI 1063483428

Title

Owner

Phone

(843) 766-9868

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 5

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

• Edward A. Kotz III, MD

  • Dermatology Physician
  • Charleston, SC
  • NPI 1063483428
  Medicare reassignment Care Compare group Authorized official
• Amanda H. Wright, PA

  • Dermatology Physician
  • Charleston, SC
  • NPI 1922244086
  Medicare reassignment Care Compare group
• Danielle Schimpf Dubiel, PA-C

  • Dermatology Physician
  • Shenandoah, TX
  • NPI 1801265319

  SC

  Medicare reassignment Care Compare group
• Tracy Leigh Cordray, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Charleston, SC
  • NPI 1346432614
  NPD (past)
• Anne Louise Edwards, MD

  • Plastic Surgery Physician
  • Charleston, SC
  • NPI 1942258561
  NPD (past)

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295308800000",
    "number": "1639202294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 SAINT ANDREWS BLVD.",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29407",
            "telephone_number": "843-766-9868",
            "fax_number": "843-571-4925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 SAINT ANDREWS BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29407",
            "telephone_number": "843-766-9868",
            "fax_number": "843-571-4925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA DERMATOLOGY CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2011-01-18",
        "status": "A",
        "authorized_official_last_name": "KOTZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-766-9868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "SC",
            "license": "24039",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "24039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240395",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GROUPGP4945",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolina Behavioral Specialists, LLC (Maryland Behavioral Specialists)
• Carolina Center for Pain & Rehabilitation
• Carolina Center of Gynecological Oncology PA
• Carolina Chiropractic
• Carolina Coast Behavioral Services, LLC
• Carolina Eyecare Physicians, LLC
• Carolina Eyecare Physicians, LLC
• Carolina Eyes
• Carolina Family Care (MUSC Physicians PC Anesthesiology)
• Carolina Family Care (MUSC Health Centerspace)

• Dermatology Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; 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.