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NPI Code Detail

MEDICARE: EASTERN DERMATOLOGY & PATHOLOGY, PA

MEDICARE: EASTERN DERMATOLOGY & PATHOLOGY, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2230298OTHERNCMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101498OTHERNCBCBSNC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760713671
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERN DERMATOLOGY & PATHOLOGY, PA
Provider Business Mailing Address
First Line : 420 SPRING FOREST RD
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-7244
Country : US
Telephone Number : 252-752-4124
Fax Number : 252-752-6106
Provider Business Practice Location Address
First Line : 1314 HIGHLAND DR
Second Line :
City : WASHINGTON
State : NC
Zip : 27889-3424
Country : US
Telephone Number : 252-752-4124
Fax Number : 252-752-6106
Authorized Official
Title or Position : PRESIDENT
Name : DR. CAMERON LANGLEY SMITH
Credential : MD
Telephone Number : 252-752-4124
Provider Enumeration Date : 01/18/2010
Last Update Date : 08/22/2011

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Directions to “EASTERN DERMATOLOGY & PATHOLOGY, PA ” Practice Location

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