WESTGATE DERMATOLOGY AND LASER CENTER, P.A. (NPI# 1821240995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821240995 |
| Entity Type | Organization |
| Organization Name | WESTGATE DERMATOLOGY AND LASER CENTER, P.A. |
| Practice Address |
2020 Peace Haven Rd Winston Salem NC 27106-4851 |
| Practice Telephone | 3367681280 |
| Mailing Telephone | 3367681280 |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2012-10-02 |
| Authorized Official Name | PAUL J KOSTUCHENKO (PRESIDENT) |
| Authorized Official Telephone | 3367681280 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0900X |
Dermatology Specialization: Dermatopathology |
NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | SC MEDICAID | QPB766 | 01 |
| NC | 5950698 | 05 | |
| SC | QPB766 | 05 |
| Street Address |
2020 PEACE HAVEN RD |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27106-4851 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497756647 | Alan D Klein | Dermatology | 2020 Peace Haven Rd, Winston Salem, NC 27106-4851 | 2005-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437799103 | Tyler Laura Lawrence | Behavioral Analyst | 1959 N Peace, 104, Winston-salem, NC 27106 | 2020-01-10 |
| 1316504624 | Amanda Baker | Behavior Technician | 1959 N Peace Haven Rd, Suite 104, Winston Salem, NC 27106 | 2019-05-22 |
| 1679030316 | Lavonda Williams | Behavior Technician | 1959 N Peace Haven Road, Winston Salem, NC 27106 | 2019-03-01 |
| 1518436708 | Angela Ruth Brown | Physical Therapy Assistant | 190 Moravian Way Drive, Winston-salem, NC 27106 | 2018-11-16 |
| 1407378896 | Applied Family Services of Winston-salem | Early Intervention Provider Agency | 4220 Witherow Rd, Winston Salem, NC 27106 | 2017-07-07 |
| 1750801676 | Julia Ann Horton | Speech-Language Pathologist | 2000 Salemtowne Drive, Winston Salem, NC 27106 | 2017-06-21 |
| 1124548037 | Tyler John Jones | Community Health Worker | 7014 Brandemere Ln. Apt F, Winston Salem, NC 27106 | 2017-06-21 |
| 1396274759 | Jennifer Cui | Social Worker | 3216 Cross Tree Rd, Winston-salem, NC 27106 | 2017-06-08 |
| 1063947802 | Rebecca Jeanette Mclemore | Social Worker | 4401 Providence Ln. #121, Top Priority Care Services, LLC., Winston-salem, NC 27106 | 2017-05-01 |
| 1720529357 | Rising Hope Clinical Assistance, LLC | Community/Behavioral Health | 510 Northgate Park Dr, Winston Salem, NC 27106 | 2017-03-15 |
| Find all providers in zip 27106 | ||||
| Taxonomy Code | 207ND0900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Dermatopathology |
| A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972591055 | Paul J Kostuchenko | Dermatology | 1345 Westgate Center Dr Ste B, Winston Salem, NC 27103-3041 | 2005-10-12 |
| 1255316311 | Rita O Pichardo-geisinger | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073667077 | Earl George Gross | Dermatology | 3610 Medical Park Court, Morehead City, NC 28557 | 2007-01-23 |
| 1588959894 | Dana Haydel | Dermatology | 706 Green Valley Rd Ste 104, Greensboro, NC 27408 | 2011-06-14 |
| 1841344843 | Crystal Coast Dermatology Services, Pa | Dermatology | 3610 Medical Park Court, Morehead City, NC 28557 | 2007-01-23 |
| 1609961853 | Scott David Mcclellan | Dermatology | 2115 Neuse Blvd, New Bern, NC 28560-4309 | 2006-10-04 |
| 1962411017 | Hee Kim Park | Dermatology | 420 Spring Forest Rd, Greenville, NC 27834-7244 | 2006-08-07 |
| 1104847714 | Polley Clinic of Dermatology & Dermatologic Surgery | Dermatology | 1806 Glendale Dr Sw, Wilson, NC 27893-4402 | 2006-07-21 |
| 1619903176 | Dermatology Associates of Coastal Carolina, Pa | Dermatology | 2115 Neuse Blvd, New Bern, NC 28560-4309 | 2006-06-24 |
| City | WINSTON SALEM |
| Zip Code | 27106 |
Please comment or provide details below to improve the information on WESTGATE DERMATOLOGY AND LASER CENTER, P.A..
| 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.