Frederick Park (NPI# 1407964547, PAC ID# 2062488430) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PLASTIC AND RECONSTRUCTIVE SURGERY.
| Nation Provider ID (NPI) | 1407964547 |
| PAC ID by PECOS | 2062488430 |
| Professional Enrollment ID | I20040911000250 |
| Full Name | Frederick Park |
| Organization Legal Name | WILMINGTON DERMATOLOGY CENTER, PLLC |
| Address |
710 Military Cutoff Rd Suite 320 Wilmington NC 28405-2382 |
| Phone Number | 9102564350 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF ILLINOIS AT CHICAGO HEALTH SCIENCE CENTER |
| Graduation Year | 1983 |
| Primary Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| Group Practice PAC ID | 0042385627 |
| Number of Group Practice Members | 6 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 340147 | NASH GENERAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 6372 Mechanicsville Tpke, Suite 103, Mechanicsville, VA 23111-4710 | 8043790116 | JAMES RIVER DERMATOLOGY PLLC |
| 6372 Mechanicsville Tpke, Mechanicsville, VA 23111-4710 | 8043790116 | JAMES RIVER DERMATOLOGY PLLC |
| 1316 Alverser Plz, Midlothian, VA 23113-2604 | 8043790116 | JAMES RIVER DERMATOLOGY PLLC |
| 2460 Curtis Ellis Dr, Rocky Mount, NC 27804-2237 | 2524438030 | PARK PLASTIC SURGERY PA |
| 4008 Capital Dr, Rocky Mount, NC 27804-3123 | 2529375003 | PARK PLASTIC SURGERY PA |
| 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 | 9102564350 | WILMINGTON DERMATOLOGY CENTER, PLLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| MIPS_EC_130_overall | Documentation of Current Medications in the Medical Record | 100% |
| Organization Legal Name | WILMINGTON DERMATOLOGY CENTER, PLLC |
| Physicians | 7 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kelly M Britt | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Rosalyn George | Dermatology | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Karin K Hipp | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Lorien S Lamar | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Andrea C Villareal | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Beth A Rankin | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Street Address |
710 MILITARY CUTOFF RD SUITE 320 |
| City | WILMINGTON |
| State | NC |
| Zip | 28405-2382 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Greg Viehman | Dermatology | 710 Military Cutoff Rd, Suite 200, Wilmington, NC 28405-2374 | |
| Kelly M Britt | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Rosalyn George | Dermatology | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Karin K Hipp | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Lorien S Lamar | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Andrea C Villareal | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Beth A Rankin | Physician Assistant | Wilmington Dermatology Center, Pllc | 710 Military Cutoff Rd, Suite 320, Wilmington, NC 28405-2382 |
| Sarah C Holt | Physician Assistant | Seacoast Skin Surgery Pllc | 710 Military Cutoff Rd, Suite 200, Wilmington, NC 28405-2374 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amanda Rae Gillilan | Physical Medicine and Rehabilitation | Carolina Rehabilitation Inc | 1722 A N Kerr Ave, Wilmington, NC 28405-1038 |
| Regina M Jensen | Internal Medicine | 4536 Technology Dr, Suite 3, Wilmington, NC 28405-2153 | |
| Perry J Castellano | Optometry | 5351 Gingerwood Dr, Wilmington, NC 28405-3091 | |
| Tracy A Novosel | Dermatology | Dermatology Associates Pa | 6781 Parker Farm Dr, Suite 300, Wilmington, NC 28405-3161 |
| Vaishali G Escaravage | Dermatology | Dermatology Associates Pa | 6781 Parker Farm Dr, Suite 300, Wilmington, NC 28405-3161 |
| Nancy M Cunningham | Dermatology | Dermatology Associates Pa | 6781 Parker Farm Dr, Suite 300, Wilmington, NC 28405-3161 |
| Marie N Hardy | Dermatology | Dermatology Associates Pa | 6781 Parker Farm Dr, Suite 300, Wilmington, NC 28405-3161 |
| Kimberly P Edwards | Dermatology | Dermatology Associates Pa | 6781 Parker Farm Dr, Suite 300, Wilmington, NC 28405-3161 |
| William Sargent Kaufman | Dermatology | Dermatology Associates Pa | 6781 Parker Farm Dr, Suite 300, Wilmington, NC 28405-3161 |
| Holly C Shaffer | Dermatology | Dermatology Associates Pa | 6781 Parker Farm Dr, Suite 300, Wilmington, NC 28405-3161 |
| Find all physicians in zip 28405 | |||
| City | WILMINGTON |
| Zip Code | 28405 |
| Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| City + Specialty | WILMINGTON + PLASTIC AND RECONSTRUCTIVE SURGERY |
Please comment or provide details below to improve the information on Frederick Park.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.