Healthcare Provider Details

I. General information

NPI: 1457722043
Provider Name (Legal Business Name): EASTERM DERMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SPRING FOREST RD
GREENVILLE NC
27834-7244
US

IV. Provider business mailing address

1165 CEDAR POINT BLVD SUIE F
CEDAR POINT NC
28584-8023
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-4124
  • Fax: 252-758-8954
Mailing address:
  • Phone: 252-764-2986
  • Fax: 252-758-8954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. CAMERON L SMITH
Title or Position: PARTNER
Credential: MD
Phone: 252-752-4124