NPIMap

Organization Active NPI

Wilmington Dermatology Center, PLLC

  • Dermatology Physician
  • Wilmington, NC
National Provider Identifier
1750537858
Registry record updated Nov 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
2008-00054 Issued in NC
Legal business name
WILMINGTON DERMATOLOGY CENTER, PLLC
Practice address
710 Military Cutoff Rd
Suite 320
Wilmington, NC 28405-2375
Phone
(910) 256-3450
Fax
(910) 239-5032
NPI assigned
Aug 8, 2008
Last updated
Nov 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2012

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

Authorized official

Name
Dr. Rosalyn Elizabeth George, M.D.NPI 1639391931
Title
President
Phone
(910) 256-4350

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 Physician 207N00000X 2008-00054 NC Primary

Addresses

Primary practice location

710 Military Cutoff Rd
Suite 320
Wilmington, NC 28405-2375

Mailing address

710 Military Cutoff Rd
Suite 320
Wilmington, NC 28405-2375
Phone (910) 256-3450

Other identifiers 1

IdentifierTypeStateIssuer
1639391931OtherNCPERSONAL PHYSICIAN NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080815000446 NC Part B Supplier - Clinic/Group Practice 0042385627 Receives reassigned benefits from 9 practitioners
Practice locations: Wilmington, NC

National Provider Directory

National Provider Directory

Locations

710 Military Cutoff Rd
Ste 320
Wilmington, NC 28405
Phone (910) 256-3450

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EHDFAA

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353369600000",
    "number": "1750537858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 MILITARY CUTOFF RD",
            "address_2": "SUITE 320",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284052375",
            "telephone_number": "910-256-3450",
            "fax_number": "910-239-5032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 MILITARY CUTOFF RD",
            "address_2": "SUITE 320",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284052375",
            "telephone_number": "910-256-3450",
            "fax_number": "910-239-5032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON DERMATOLOGY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-08",
        "last_updated": "2012-11-20",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "ROSALYN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-256-4350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2008-00054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL PHYSICIAN NPI",
            "identifier": "1639391931",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; 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.