Active NPI
Crystal Coast Dermatology Services, PA
- Dermatopathology Physician
- Morehead City, NC
National Provider Identifier
1841344843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatopathology Physician
- License
- 99-00855
- Legal business name
- CRYSTAL COAST DERMATOLOGY SERVICES, PA
- Practice address
- 3610 Medical Park Court
Morehead City, NC 28557 - Phone
- (252) 808-3376
- Fax
- (252) 808-2095
- NPI assigned
- Jan 23, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Earl George Gross, M.D.
- Title
- President
- Phone
- (252) 808-3376
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology Physician | 207ND0900X | 99-00855 | NC | Primary |
Addresses
Primary practice location
3610 Medical Park Court
Morehead City, NC 28557
Mailing address
PO Box 927
Morehead City, NC 28557-0927
Phone (252) 808-3376
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89011A5 | Medicaid | NC | |
| 011A5 | Other | NC | BLUE CROSS OF NC |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dermatology Physician
- Coraopolis, PA
- NPI 1447468970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1841344843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 927",
"city": "MOREHEAD CITY",
"state": "NC",
"postal_code": "285570927",
"telephone_number": "252-808-3376",
"fax_number": "252-808-2095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3610 MEDICAL PARK COURT",
"city": "MOREHEAD CITY",
"state": "NC",
"postal_code": "28557",
"telephone_number": "252-808-3376",
"fax_number": "252-808-2095"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CRYSTAL COAST DERMATOLOGY SERVICES, PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-23",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "GROSS",
"authorized_official_first_name": "EARL",
"authorized_official_middle_name": "GEORGE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "252-808-3376",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207ND0900X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Dermatopathology",
"state": "NC",
"license": "99-00855",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89011A5",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF NC",
"identifier": "011A5",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Morehead City, NC
- Beverly B. Cozort, D.D.S.
- Katherine Craig, LCSW-A
- Tia Renee Crooms, LMFT
- Maria L. Cruz, MS. LMFT
- Crystal Coast Care for Women PC
- Crystal Coast Family Practice
- Crystal Coast Hearing Solutions Inc
- Crystal Coast Pain Management Center, PLLC
- Crystal Coast Therapy Company, PC
- Crystal Coast Wellness and Performance Center
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.