Hendersonville Dermatology, PLLC
Organization Active NPI Dermatology Physician · Flat Rock, NC
NPI 1770949398 · NPPES record last updated Jan 17, 2019
Key facts
- NPI
- 1770949398
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 33967 (NC)
- Legal business name
- HENDERSONVILLE DERMATOLOGY, PLLC
- Practice address
- 15 Market Center Dr
Ste a
Flat Rock, NC 28731-8528 - Phone
- (828) 697-1170
- Fax
- (828) 698-4939
- NPI assigned
- Jan 12, 2016
- Organization subpart
- No
Authorized official
- Name
- Seth Joseph Cohen, MD
- Title
- Owner
- Phone
- (828) 697-1170
Practitioners 3
-
Jacqueline Marie Selph, M.D.
-
Brianna Dallison Wiener, NP-C
-
Seth Cohen, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2109355 | Hendersonville Dermatology, PLLC | Compliance | Jan 28, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160219000882 | NC | Part B Supplier - Clinic/Group Practice | 3577868108 |
Receives reassigned benefits from 3 practitioners Practice locations: Flat Rock, NC |
National Provider Directory
Locations
15 Market Center Dr
Ste A
Flat Rock, NC 28731
Phone (828) 697-1170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | 33967 | NC | Yes |
Addresses
Primary practice location
15 Market Center Dr
Ste a
Flat Rock, NC 28731-8528
Mailing address
15 Market Center Dr Ste a
Flat Rock, NC 28731-8529
Phone (828) 697-1170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DW3295 | Other | NC | RAILROAD MEDICARE |
| F459 | Other | NC | MEDICARE |
Other providers in Flat Rock, NC
- Helping Hand Developmental Center
- Henderson County Hospital Corp
- Henderson County Hospital Corporation
- Henderson Opco, LLC
- Jennifer Lenore Henderson
- Hendersonville Health and Rehabilitation
- Ronald Walter Hertwig Jr.
- Winnie Claire Hicks
- Nina Hill
- Amy Elizabeth Hinton
All providers in Flat Rock, NC · Dermatology Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.