NPIMap

Organization Active NPI

Triad Dermatology PA

  • Dermatology Physician
  • Winston Salem, NC
National Provider Identifier
1699836908
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
28663 Issued in NC
Legal business name
TRIAD DERMATOLOGY PA
Practice address
725 Highland Oaks Drive
Suite 106
Winston Salem, NC 27103
Phone
(336) 768-2180
Fax
(336) 768-8031
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Debra C Liu, MD
Title
Owner
Phone
(336) 768-2180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 28663 NC Primary

Addresses

Primary practice location

725 Highland Oaks Drive
Suite 106
Winston Salem, NC 27103

Mailing address

725 Highland Oaks Drive
Suite 106
Winston Salem, NC 27103
Phone (336) 768-2180

National Provider Directory

National Provider Directory

Locations

725 Highland Oaks Dr
Ste 106
Winston Salem, NC 27103
Phone (336) 768-2180

725 Highland Oaks Dr
Ste 1
Winston Salem, NC 27103
Phone (336) 768-2180

Practitioners & affiliated clinicians

Practitioners 3

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": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699836908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 HIGHLAND OAKS DRIVE",
            "address_2": "SUITE 106",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-768-2180",
            "fax_number": "336-768-8031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 HIGHLAND OAKS DRIVE",
            "address_2": "SUITE 106",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-768-2180",
            "fax_number": "336-768-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-768-2180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NC",
            "license": "28663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.