NPIMap

Organization Active NPI

Eastern Dermatology PA

  • Dermatology Physician
  • Edenton, NC
National Provider Identifier
1972715241
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EASTERN DERMATOLOGY PA
Practice address
222 Virginia Rd
Edenton, NC 27932-9667
Phone
(252) 482-5661
Fax
(252) 758-8954
NPI assigned
May 7, 2007
Last updated
Oct 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Dr. Cameron Langley Smith, MDNPI 1770504060
Title
President
Phone
(252) 752-4124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

222 Virginia Rd
Edenton, NC 27932-9667

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
01498OtherNCBCBS NC
5902502MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624001141 NC Part B Supplier - Clinic/Group Practice 2860478542 Receives reassigned benefits from 21 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Newport, NC; Washington, NC; New Bern, NC; Greenville, NC; Elizabeth City, NC; Edenton, NC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

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

Other organizations with this tax ID 5

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

Locations

222 Virginia Rd
Edenton, NC 27932
Phone (252) 355-4890

1705 W 6th St
Ste G
Greenville, NC 27834

2577 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 752-1406

420 Spring Forest Rd
Greenville, NC 27834

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1972715241",
    "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": "252-758-8954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 VIRGINIA RD",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279329667",
            "telephone_number": "252-482-5661",
            "fax_number": "252-758-8954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2007-10-11",
        "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": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "01498",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902502",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edenton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.