LAKE NORMAN DERMATOLOGY, PA (NPI# 1184754848) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184754848 |
| Entity Type | Organization |
| Organization Name | LAKE NORMAN DERMATOLOGY, PA |
| Practice Address |
140 Leaning Oak Drive Ste 101 Mooresville NC 28117-6991 |
| Practice Telephone | 7046589730 |
| Practice Fax Number | 7046581457 |
| Mailing Telephone | 7046589730 |
| Mailing Fax Number | 7046581457 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-09-21 |
| Authorized Official Name | JOEL H SUGARMAN (PRESIDENT) |
| Authorized Official Telephone | 7046589730 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 200500264 | Allopathic & Osteopathic Physicians | |
| Y | 174400000X | Specialist | 200500264 | NC | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS ID NUMBER | 14002 | 01 |
| BC/BS | 021AU | 01 |
| Street Address |
140 LEANING OAK DRIVE STE 101 |
| City | MOORESVILLE |
| State | NC |
| Zip Code | 28117-6991 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720039399 | Joel H Sugarman | Dermatology | 140 Leaning Oak Drive, Ste 101, Mooresville, NC 28117-6991 | 2006-05-16 |
| 1497047278 | Allison B Hanley | Physician Assistant | 140 Leaning Oak Drive, Suite 101, Mooresville, NC 28117-6991 | 2011-05-11 |
| 1417006115 | Melissa R Moser | Physician Assistant | 140 Leaning Oak Drive, Ste 101, Mooresville, NC 28117-6991 | 2007-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891356648 | Teleoptometric Service, P.C. | Optometrist | 392 Talbert Rd, Mooresville, NC 28117 | 2019-06-24 |
| 1992268544 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 392 Talbert Rd., Mooresville, NC 28117 | 2019-04-10 |
| 1982178042 | Langtree Endoscopy Center, LLC | Clinic/Center | 106 Alexander Bank Drive, Suite 101, Mooresville, NC 28117 | 2019-01-11 |
| 1679044416 | May and Associates Therapy Center | Psychologist | 862 Brawley School Road, Suite 202, Mooresville, NC 28117 | 2018-12-05 |
| 1700360153 | Sabrina Chabot Hutchinson | Physical Therapist | 508 Williamson Rd, Suite 200, Mooresville, NC 28117 | 2018-09-21 |
| 1992284327 | Presbyterian Imaging Centers LLC | Radiology | 106 Langtree Village Dr # 201, Mooresville, NC 28117 | 2018-08-07 |
| 1073091310 | Jenelle Donzelli Nemeth | Registered Nurse | 102 Sapphire Drive, Mooresville, NC 28117 | 2018-07-30 |
| 1912497496 | Patsharx LLC | Pharmacy | 480 River Hwy, Suite A, Mooresville, NC 28117 | 2018-05-10 |
| 1427502434 | Counseling Service At Lake Norman, Pllc | Community/Behavioral Health | 18117 W. Catawba Avenue, Cornelius, NC 28117 | 2016-08-08 |
| 1447605928 | Renewal Counseling, Pllc | Counselor | 125 Commerce Park Rd., Suite 102, Mooresville, NC 28117 | 2016-05-03 |
| Find all providers in zip 28117 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912342676 | Stephen Herrick Cruikshank | Specialist | 122 Gateway Blvd Ste 200, Mooresville, NC 28117-5544 | 2013-05-07 |
| 1396806071 | Karen Y Davies | Specialist | 363 Williamson Rd Ste 101, Mooresville, NC 28117-5974 | 2006-12-13 |
| 1952402364 | South Iredell Internal Medicine, Pa | Specialist | 146 Medical Park Rd Ste 106, Mooresville, NC 28117-8529 | 2006-09-26 |
| 1669581781 | Steven H Bradley | Specialist | 146 Medical Park Rd Ste 108, Mooresville, NC 28117 | 2006-08-30 |
| 1508870791 | Donald L Cohen | Specialist | 132 Gateway Blvd, Mooresville, NC 28117-5540 | 2006-07-27 |
| 1710916960 | Lake Norman Plastic Surgery | Specialist | Lake Norman Medical & Professional Plaza, Suite 106, 146 Medical Park Rd., Mooresville, NC 28117 | 2006-07-01 |
| 1134171366 | Lake Norman Urology Pllc | Specialist | 137 Professional Park Drive, Suite D, Mooresville, NC 28117-8522 | 2006-05-16 |
| 1144279720 | Cherryl Ann Jedele I | Specialist | 625 St Rd 67 S, Mooresville, IN 46158-1710 | 2006-05-09 |
| 1710970025 | Gregory Bruno Hall | Specialist | 150 Fairview Rd, Suite 300, Mooresville, NC 28117-9504 | 2005-08-23 |
| 1942202015 | Olaf B Johansen | Specialist | 1215 Hadley Rd, Ste 201, Mooresville, IN 46158-2905 | 2005-06-02 |
| Find all providers in MOORESVILLE | ||||
| City | MOORESVILLE |
| Zip Code | 28117 |
Please comment or provide details below to improve the information on LAKE NORMAN DERMATOLOGY, PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.