NPIMap

Organization Active NPI

Eastern Dermatology & Pathology, PA

  • Dermatology Physician
  • Washington, NC
National Provider Identifier
1760713671
Registry record updated Aug 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EASTERN DERMATOLOGY & PATHOLOGY, PA
Practice address
1314 Highland Dr
Washington, NC 27889-3424
Phone
(252) 752-4124
Fax
(252) 752-6106
NPI assigned
Jan 18, 2010
Organization subpart
Yes
Parent organization
EASTERN DERMATOLOGY & PATHOLOGY, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2011

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

Authorized official

Name
Dr. Cameron Langley Smith, MD
Title
President
Phone
(252) 752-4124

Specialties & licenses 1

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

Addresses

Primary practice location

1314 Highland Dr
Washington, NC 27889-3424

Mailing address

420 Spring Forest Rd
Greenville, NC 27834-7244
Phone (252) 752-4124

Other identifiers 3

IdentifierTypeStateIssuer
01498OtherNCBCBSNC
230298OtherNCMEDICARE
8901498MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Eastern Dermatology P6 organizations share this tax ID, including this one
Part of
Eastern Dermatology P

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

420 Spring Forest Rd
Greenville, NC 27834

1314 Highland Dr
Washington, NC 27889
Phone (252) 948-0101

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1263772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313971200000",
    "number": "1760713671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SPRING FOREST RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347244",
            "telephone_number": "252-752-4124",
            "fax_number": "252-752-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 HIGHLAND DR",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278893424",
            "telephone_number": "252-752-4124",
            "fax_number": "252-752-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN DERMATOLOGY & PATHOLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTERN DERMATOLOGY & PATHOLOGY, PA",
        "enumeration_date": "2010-01-18",
        "last_updated": "2011-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "LANGLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-752-4124",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "01498",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "230298",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901498",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; 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.