Intracoastal Dermatology and Skin Surgery PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTRACOASTAL DERMATOLOGY AND SKIN SURGERY PLLC

Practice address

509 Olde Waterford Way Ste 103
Leland, NC 28451-4126

Phone

(910) 631-0301

Fax

(910) 292-1230

NPI assigned

Oct 20, 2023

Last updated

Apr 28, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Blair Harris, DONPI 1376001479

Title

Member/Organizer

Phone

(910) 631-0301

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

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.

• Blair Walter Harris, DO

  • Dermatology Physician
  • Leland, NC
  • NPI 1376001479
  Medicare reassignment Care Compare group NPD Authorized official
• Jenna Hester, PA-C

  • Physician Assistant
  • Leland, NC
  • NPI 1932945276
  Medicare reassignment Care Compare group
• Sarah Justice

  • Medical Physician Assistant
  • Leland, NC
  • NPI 1568251650
  Medicare reassignment

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

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1871375055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 OLDE WATERFORD WAY STE 103",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284514126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 OLDE WATERFORD WAY STE 103",
            "city": "LELAND",
            "state": "NC",
            "postal_code": "284514126",
            "telephone_number": "910-631-0301",
            "fax_number": "910-292-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTRACOASTAL DERMATOLOGY AND SKIN SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-20",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "BLAIR",
        "authorized_official_title_or_position": "MEMBER/ORGANIZER",
        "authorized_official_telephone_number": "910-631-0301",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Michael Hrvol III, DC
• Heather Piedra Hughes, LCSW
• Sarah Thompson Ihnat, DPT
• Institutional Pharmacy Solutions
• Institutional Pharmacy Solutions, LLC
• Intracoastal Medical Solutions PLLC (Coastline Wellness)
• Frederick B Ireland, DPT
• Riley Elizabeth Isom, LCSWA
• Jackson Eye Associates, OD PA
• Jennifer Michelle Jackson, PA-C

• Dermatology Physician in Leland, NC
• Providers in Leland, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.