Provider Demographics
NPI:1023358231
Name:DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-633-4461
Mailing Address - Street 1:PO BOX 890283
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0283
Mailing Address - Country:US
Mailing Address - Phone:252-633-4461
Mailing Address - Fax:252-633-6016
Practice Address - Street 1:3332 BRIDGES ST
Practice Address - Street 2:SUITE B
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3280
Practice Address - Country:US
Practice Address - Phone:252-633-4461
Practice Address - Fax:252-633-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty