Healthcare Provider Details

I. General information

NPI: 1942713052
Provider Name (Legal Business Name): VIETA DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 TROTTER HILLS CIR
PINEHURST NC
28374-7930
US

IV. Provider business mailing address

10 TROTTER HILLS CIR
PINEHURST NC
28374-7930
US

V. Phone/Fax

Practice location:
  • Phone: 910-420-1282
  • Fax: 910-420-1116
Mailing address:
  • Phone: 910-420-1282
  • Fax: 910-420-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2014-02302
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number2014-02302
License Number StateNC

VIII. Authorized Official

Name: SARAH GRUMMER
Title or Position: OWNER
Credential: MD
Phone: 239-595-5124