METROLINA DERMATOLOGY AND SKIN SURGERY SPECIALISTS, PLLC (NPI# 1619400033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619400033 |
| Entity Type | Organization |
| Organization Name | METROLINA DERMATOLOGY AND SKIN SURGERY SPECIALISTS, PLLC |
| Practice Address |
10502 Park Rd Charlotte NC 28210-8479 |
| Mailing Address |
5300 Far Hills Ave Dayton OH 45429-2381 |
| Practice Telephone | 9374337536 |
| Mailing Telephone | 9374337536 |
| Mailing Fax Number | 9374339612 |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2017-04-04 |
| Authorized Official Name | MICHAEL P CONROY (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 6147601401 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
10502 PARK RD |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28210-8479 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255321972 | Aaron T Blackmer | Physician Assistant | 10502 Park Rd, Suite 100, Charlotte, NC 28210-8479 | 2005-10-25 |
| 1578086187 | Carolinas Medical Center | Internal Medicine | 10502 Park Rd, Suite 110, Charlotte, NC 28210-8479 | 2017-07-25 |
| 1497181762 | Catherine Blair | Nurse Practitioner | 10502 Park Rd, Suite 150, Charlotte, NC 28210-8479 | 2013-09-18 |
| 1518222132 | Moose Hand Center, Pllc | Surgery | 10502 Park Rd, Suite 170, Charlotte, NC 28210-8479 | 2012-07-10 |
| 1407144744 | David Olson | Internal Medicine | 10502 Park Rd, Ste 150, Charlotte, NC 28210-8479 | 2011-07-20 |
| 1669793303 | Corlan Eboh | Internal Medicine | 10502 Park Rd, Ste 150, Charlotte, NC 28210-8479 | 2010-06-17 |
| 1861719494 | Sasha Jenkins Haberle | Dermatology | 10502 Park Rd, Ste 100, Charlotte, NC 28210-8479 | 2010-04-21 |
| 1528380763 | Box Arthritis & Rheumatology of The | Clinic/Center | 10502 Park Rd, Suite 100, Charlotte, NC 28210-8479 | 2010-02-15 |
| 1265607907 | Nicholas Anthony | Internal Medicine | 10502 Park Rd, Ste 150, Charlotte, NC 28210-8479 | 2008-04-24 |
| 1821260498 | Thomas D Smith Dmd | Dentist | 10502 Park Rd, Suite 170, Charlotte, NC 28210-8479 | 2008-03-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952920860 | Rx Care 14 LLC | Pharmacy | 7701 Sharon Lakes Road, Suite H, Charlotte, NC 28210 | 2020-04-10 |
| 1427697622 | David Durant Dinsmore | Nurse Anesthetist, Certified Registered | Atrium Health Pineville, 10628 Park Road, Charlotte, NC 28210 | 2020-01-06 |
| 1790256964 | Tele Phys Inc | Internal Medicine | 10035 Park Center Dr., Ste 100, Charlotte, NC 28210 | 2018-12-16 |
| 1104395896 | Bridgett Williams | Behavior Technician | 7806 Andover Woods Drive, Charlotte, NC 28210 | 2018-11-26 |
| 1053880518 | Low-t Physicians Professional Association | Internal Medicine | 10430 Park Road Suite 100a, Charlotte, NC 28210 | 2018-11-14 |
| 1053895102 | Carolinas Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 7701 Sharon Lakes Blvd, Ste A., Charlotte, NC 28210 | 2018-09-24 |
| 1679066658 | Afc Urgent Care and Family Care of Wnc, Pllc | Clinic/Center | 10102 Johnston Rd, Charlotte, NC 28210 | 2018-06-13 |
| 1346777018 | Hopeway Foundation | Clinic/Center | 1717 Sharon Road West, Charlotte, NC 28210 | 2017-05-12 |
| 1891154688 | Jessie Lee Ogienko | Social Worker | 5960 Fairview Rd Ste 328, Charlotte, NC 28210 | 2016-02-22 |
| 1699151985 | Carolina Complete Psychiatry, Pllc | Physician Assistant | 5950 Fairview Road, Suite 708, Charlotte, NC 28210 | 2015-08-10 |
| Find all providers in zip 28210 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528035722 | Marc Ronald Carruth | Dermatology | 2615 E 7th St, Charlotte, NC 28204-4376 | 2006-03-07 |
| 1861719494 | Sasha Jenkins Haberle | Dermatology | 10502 Park Rd, Ste 100, Charlotte, NC 28210-8479 | 2010-04-21 |
| 1174783385 | Jonathan M Olson | Dermatology | 15830 Ballantyne Medical Pl, Suite 225, Charlotte, NC 28277-4653 | 2008-06-11 |
| 1790961670 | Dermatologic Surgery of The Carolinas LLC | Dermatology | 15830 Ballantyne Medical Place, Suite 225, Charlotte, NC 28277 | 2008-01-10 |
| 1083700207 | Dermatology Laser and Vein Specialists of The Carolina's, Pllc | Dermatology | 1918 Randolph Rd, Suite 550, Charlotte, NC 28207-1100 | 2006-10-05 |
| 1992734669 | The Goslen Center for Skin Wellness, P.a. | Dermatology | 1918 Randolph Rd, Suite550, Charlotte, NC 28207-1100 | 2006-07-03 |
| 1265406482 | Junius Blake Goslen IIi | Dermatology | 1918 Randolph Rd, Suite 550, Charlotte, NC 28207-1100 | 2006-02-14 |
| 1215910336 | Girish Somashekhar Munavalli | Dermatology | 1918 Randolph Rd, Suite 550, Charlotte, NC 28207-1100 | 2005-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942713052 | Vieta Dermatology, Pllc | Dermatology | 289 Olmsted Blvd Ste 5, Pinehurst, NC 28374-8730 | 2017-11-10 |
| 1245751403 | Bluewater Dermatology and Skin Cancer Center Pa | Dermatology | 814 Spivey Rd, Whiteville, NC 28472-8736 | 2017-06-28 |
| 1831330893 | Landon Everett Stigall | Dermatology | 6752 Rock Spring Rd Ste 201, Wilmington, NC 28405 | 2009-03-20 |
| 1780772541 | Jenny L. Stone | Dermatology | 203 Mocksville Ave Ste B, Salisbury, NC 28144-3360 | 2006-10-10 |
| 1215902663 | Frederick Walter Gourdin | Dermatology | 78 Long Shoals Rd, Arden, NC 28704-7782 | 2006-02-21 |
| 1508846403 | Rajat Varma | Dermatology | 410 Market St Ste 400, Unc Dept of Dermatology, Chapel Hill, NC 27516-4061 | 2006-01-18 |
| 1437130523 | Greg Edwin Viehman | Dermatology | 710 Military Cutoff Rd, Suite 200, Wilmington, NC 28405-2375 | 2005-11-07 |
| 1598759482 | Eastern Dermatology, P.a. | Dermatology | 420 Spring Forest Rd, Greenville, NC 27834-7244 | 2005-09-07 |
| 1285636076 | Charles S Johnson | Dermatology | 315 19th St Se, Hickory, NC 28602-4230 | 2005-08-11 |
| 1134123847 | Audrey F Echt | Dermatology | 10931 Raven Ridge Rd, Ste 101, Raleigh, NC 27614-6499 | 2005-06-09 |
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| 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.