Organization Active NPI

Mountain Laurel Dermatology, PLLC

  • Dermatology Physician
  • Clyde, NC
National Provider Identifier
1700298635
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MOUNTAIN LAUREL DERMATOLOGY, PLLC
Practice address
11 Falcon Crest LN
Clyde, NC 28721-6620
Phone
(828) 565-0560
NPI assigned
May 27, 2014
Last updated
Jan 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Dr. Gina R Singleton, M.D.NPI 1033104369
Title
Managing Physician
Phone
(828) 565-0560

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X NC Primary

Addresses

Primary practice location

11 Falcon Crest LN
Clyde, NC 28721-6620

Mailing address

PO Box 1921
Clyde, NC 28721-1900
Phone (828) 565-0560

Other practice location 1

11 Falcon Crest Lane
Clyde, NC 28721
Phone (828) 565-0560

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0247590Mountain Laurel Dermatology, PLLC11 Falcon Crest Lane, Clyde, NC 28721Provider-performed microscopyOct 12, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1700298635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1921",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287211900",
            "telephone_number": "828-565-0560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 FALCON CREST LN",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287216620",
            "telephone_number": "828-565-0560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Falcon Crest Lane",
            "address_purpose": "LOCATION",
            "city": "Clyde",
            "state": "NC",
            "postal_code": "28721",
            "country_code": "US",
            "telephone_number": "828-565-0560",
            "fax_number": "828-565-0562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOUNTAIN LAUREL DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "SINGLETON",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "828-565-0560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clyde, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.