FORA DERMATOLOGY PLLC
NPI 1366086597
Dermatology - MOHS-Micrographic Surgery in Mooresville, NC

Q: What is Fora Dermatology PLLC's NPI number?

The NPI number for Fora Dermatology PLLC is 1366086597. It was assigned to this organization in the NPPES registry on October 31, 2019.

Q: What is Fora Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Active since October 31, 2019CLIA Certified · 3 labs

118 GATEWAY BLVD STE A, MOORESVILLE, NC 28117(704) 230-1302(704) 230-1284 Get Directions Write a Review

NPPES record last updated: June 4, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 4, 2023, Apr 20, 2021, Jan 26, 2021 and 6 more (9 updates tracked since 2019).

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About Fora Dermatology Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FORA DERMATOLOGY PLLC (NPI 1366086597), doing business as Pc Dermatology Pllc, is a healthcare organization registered as a mohs-micrographic surgery in Mooresville, North Carolina and active in the NPI registry since October 2019. The organization holds 3 active CLIA laboratory certificates, maintains a secondary practice location in Mooresville, and lists Bishr Al Dabagh, Owner, as its authorized official.

NPPES Registry Identity

NPI1366086597

Entity TypeOrganization

Primary Taxonomy207ND0101X

Legal Business NameFORA DERMATOLOGY PLLC

Location Address118 GATEWAY BLVD STE AMooresville, NC 28117-6542

Mailing Address118 Gateway Blvd Ste AMooresville, NC 28117-6542 · (704) 230-1302 · Fax (704) 230-1284

Phone(704) 230-1302

Fax(704) 230-1284

Organization SubpartNo

Authorized OfficialBishr Al DabaghOwner · (704) 230-1302

Enumeration DateOctober 31, 2019

Last NPPES UpdateJune 4, 20239 updates tracked since enumeration

NPPES CertifiedJune 4, 2023

✔ NPI 1366086597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207ND0101X

Definition

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.

Also ListedDermatologyTaxonomy 207N00000X

Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X

118 GATEWAY BLVD STE A, Mooresville, NC 28117

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Other Names 1

Former Legal Business NamePc Dermatology Pllc

Secondary Practice Location 1

Location 1128 Medical Park Rd Ste 201Mooresville, NC 28117-8579 · Phone (704) 230-1302 · Fax (704) 230-1284

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 34D2180053

Fora Dermatology · Mooresville, NC

Active · expires Mar 2, 2027

CLIA Number34D2180053

Laboratory TypePhysician Office

Certificate Effective DateMarch 3, 2025

Certificate Expiration DateMarch 2, 2027

Laboratory DirectorBishr A. Al-Dabagh

Laboratory Phone(704) 230-1302

Laboratory LocationFora Dermatology118 Gateway Boulevard, Suite A, Mooresville, NC 28117

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 34D2301206

Fora Dermatology PLLC · Mooresville, NC

Active · expires Mar 21, 2028

CLIA Number34D2301206

Laboratory TypePhysician Office

Certificate Effective DateMarch 22, 2026

Certificate Expiration DateMarch 21, 2028

Laboratory DirectorBishr A. Al-Dabagh

Laboratory Phone(704) 230-1302

Laboratory LocationFora Dermatology PLLC653 Bluefield Road Suite G, Mooresville, NC 28117

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 34D2321019

Fora Dermatology · Taylorsville, NC

Active · expires Mar 26, 2027

CLIA Number34D2321019

Laboratory TypePhysician Office

Certificate Effective DateMarch 27, 2025

Certificate Expiration DateMarch 26, 2027

Laboratory DirectorBishr A. Al-Dabagh

Laboratory Phone(704) 230-1302

Laboratory LocationFora Dermatology1668 Nc Highway 16 South, Taylorsville, NC 28681

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOHN SCOTT KEADLE DDS

Dentist (General Practice)