DR. JENNIFER MARIE DEFAZIO (NPI# 1508988742) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508988742 |
| Entity Type | Individual |
| Full Name | DR. JENNIFER MARIE DEFAZIO |
| Credential | MD |
| Practice Address |
517 Moye Blvd Fl 3 Ecu Physicians Dermatology, Moye Medical #2 Greenville NC 27834-2849 |
| Mailing Address |
Po Box 751069 East Carolina University Physicians - Dermatology Charlotte NC 28275-1069 |
| Practice Telephone | 2527443109 |
| Practice Fax Number | 2527442096 |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2012-05-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
2009-01325 | NC | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
22380 | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5912475 | 05 | |
| NC | BCBSNC | 153RU | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255443925 | Jennifer L Defazio | Dermatology | 800 Veterans Hwy, Hauppauge, NY 11788-2948 | 2006-08-31 |
| 1003318056 | Jennifer Marie Defazio | Specialist/Technologist | 4200 5th Ave, Pittsburgh, PA 15260-0001 | 2018-03-06 |
| 1235441429 | Jennifer Rose Defazio | Surgery | 5841 S Maryland Ave, Chicago, IL 60637-1447 | 2010-07-05 |
| Street Address |
517 MOYE BLVD FL 3 ECU PHYSICIANS DERMATOLOGY, MOYE MEDICAL #2 |
| City | GREENVILLE |
| State | NC |
| Zip Code | 27834-2849 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902891872 | Charles M Phillips | Dermatology | 517 Moye Blvd Fl 3, Ecu Physicians Dermatology, Greenville, NC 27834-2849 | 2005-09-15 |
| 1225094659 | Karen M Buckley | Surgery | 517 Moye Blvd Fl 3, Ecu Physicians Plastic Surgery Moye Medical Center #2, Greenville, NC 27834-2849 | 2006-04-25 |
| 1487637534 | Richard S Zeri | Surgery | 517 Moye Blvd Fl 3, Ecu Physicians Plastic Surgery, Greenville, NC 27834-2849 | 2005-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801255 | Nicholas Mcarthur Bennett | Day Training, Developmentally Disabled Services | 302 C, Greenville, NC 27834 | 2020-08-11 |
| 1275150245 | Shelby Renee Jones | Student in an Organized Health Care Education/Training Program | East Carolina University College of Nursing, 600 Moye Blvd, Greenville, NC 27834 | 2020-06-25 |
| 1194347138 | Soban Ahmad | Student in an Organized Health Care Education/Training Program | 600 Moye Blvd., Vmc Ma Room 350. Internal Medicine Resi, Mailstop #734, Greenville, NC 27834 | 2020-05-13 |
| 1427687789 | Brandon Allen Yates | Student in an Organized Health Care Education/Training Program | 435 Clinic Drive, Greenville, NC 27834 | 2020-04-07 |
| 1144854407 | Kristen Springer Dreyfus | Marriage & Family Therapist | 2609 West Arlington Blvd Suite 106, Greenville, NC 27834 | 2020-02-26 |
| 1861038606 | Southern Surgical Outpatient Surgery Center, Pa | Clinic/Center | 2457 Emerald Place, Greenville, NC 27834 | 2019-11-26 |
| 1003460569 | Shaun Fitzpatrick | Nurse Practitioner | Physicians East, Pa 1850 W. Arlington Blvd., Greenville, NC 27834 | 2019-08-01 |
| 1649831496 | Katherine Salome Ross | Genetic Counselor, MS | 524 Moye Blvd, Greenville, NC 27834 | 2019-06-24 |
| 1477011880 | Lauren Bethune Scroggs | Counselor | 2150 West 5th Street, Health Sciences Building Mailstop 688, Greenville, NC 27834 | 2019-03-05 |
| 1669998001 | Idella's Care Home | Community/Behavioral Health | 2912 Lee Ct # 9a, Greenville, NC 27834 | 2017-08-17 |
| Find all providers in zip 27834 | ||||
| Taxonomy Code | 207NS0135X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Procedural Dermatology |
| Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). |
| Notes: Source: American Board of Dermatology, 2007, www.abderm.org [1/1/2008: definition added, source added, title changed] Additional Resources: Some ABMS board certified dermatologists have completed a one-year ACGME approved fellowship in Procedural Dermatology, which has been offered since 2003. At this time the ABD does not offer subspecialty certification in Procedural Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639164528 | John Michael Humeniuk | Dermatology | 21 Memorial Medical Dr, Greenville, SC 29605-4407 | 2005-09-16 |
| 1568749299 | Dallas Dermatology | Dermatology | 4724 Wellington St, Greenville, TX 75401-4944 | 2011-11-09 |
| 1912950775 | Rogers Dermatology, Pa | Dermatology | 3b Cleveland Ct, Greenville, SC 29607-2414 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740747187 | Joyce E. Carter | Dermatology | 1404 Hope Mills Rd, Fayetteville, NC 28304-4219 | 2019-02-21 |
| 1538359708 | Richard H Shereff Md Pa | Dermatology | 139 Hunter Circle, Fayetteville, NC 28304-3408 | 2007-07-25 |
| 1508183286 | Christopher Ryan Urban | Dermatology | 78 Long Shoals Rd, Arden, NC 28704-7782 | 2010-04-21 |
| 1497815328 | Wake Dermatology Associates, Pa | Dermatology | 4414 Lake Boone Trl, Ste 408, Raleigh, NC 27607-7513 | 2006-12-11 |
| 1962593509 | Deborah Kessler Hudak | Dermatology | 8311 Bandford Way, Suite 103, Raleigh, NC 27615-2756 | 2006-09-27 |
| 1972567634 | Goldsboro Skin Center Pa | Dermatology | 2613 Hospital Rd, Goldsboro, NC 27534-9424 | 2006-04-12 |
| 1871579110 | William T Sumner | Dermatology | 335 Penny Ln, Concord, NC 28025-1221 | 2005-12-19 |
| 1477539724 | Maryanna C Ter Poorten | Dermatology | 335 Penny Ln, Concord, NC 28025-1221 | 2005-12-19 |
| 1265426571 | Carol Catherine Lekan | Dermatology | 10931 Raven Ridge Rd, Ste 101, Raleigh, NC 27614-6499 | 2005-09-01 |
| City | GREENVILLE |
| Zip Code | 27834 |
Please comment or provide details below to improve the information on DR. JENNIFER MARIE DEFAZIO.
| 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.