NPIMap

Organization Active NPI

Mecklenburg Dermatology Associates PA

  • Specialist
  • Gastonia, NC
National Provider Identifier
1902073455
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
88363 Issued in NC
Legal business name
MECKLENBURG DERMATOLOGY ASSOCIATES PA
Practice address
811 Cox Rd
Gastonia, NC 28054-3453
Phone
(704) 833-0077
Fax
(704) 865-7584
NPI assigned
May 14, 2008
Last updated
May 14, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MECKLENBURG DERMATOLOGY ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Authorized official

Name
Ms. Vanessa Fleming
Title
Manager
Phone
(704) 344-8846

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 88363 NC Primary

Addresses

Primary practice location

811 Cox Rd
Gastonia, NC 28054-3453

Mailing address

811 Cox Rd
Gastonia, NC 28054-3453
Phone (704) 833-0077

Other identifiers 1

IdentifierTypeStateIssuer
89011AXMedicaidNC

National Provider Directory

National Provider Directory
Part of
Mecklenburg Dermatology Assoc PA

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.

Practitioners & affiliated clinicians

Practitioners 1

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": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1902073455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 COX RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280543453",
            "telephone_number": "704-833-0077",
            "fax_number": "704-865-7584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 COX RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280543453",
            "telephone_number": "704-833-0077",
            "fax_number": "704-865-7584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECKLENBURG DERMATOLOGY ASSOCIATES PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MECKLENBURG DERMATOLOGY ASSOCIATES",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "FLEMING",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "704-344-8846",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "88363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011AX",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.