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SOUTHERN DERMATOLOGY, P.A.
NPI 1568415586
Specialist in Raleigh, NC

Active since May 19, 2006CLIA 34D0240587 · Certificate of Compliance
4201 LAKE BOONE TRL, SUITE 200, RALEIGH, NC 27607(919) 782-2152(919) 782-7929 Get Directions Write a Review

NPPES record last updated: February 14, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Feb 14, 2025, Apr 23, 2024 (2 updates tracked since 2024).

About Southern Dermatology, P.a. NPPES

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

SOUTHERN DERMATOLOGY, P.A. (NPI 1568415586) is a healthcare organization registered as a specialist in Raleigh, North Carolina and active in the NPI registry since May 2006. The organization holds a CLIA Certificate of Compliance certificate valid through June 1, 2027 and lists Angela Ruth Peterman, Md, as its authorized official.

NPPES Registry Identity

NPI1568415586
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSOUTHERN DERMATOLOGY, P.A.
Location Address4201 LAKE BOONE TRL, SUITE 200Raleigh, NC 27607-7511
Mailing Address1306 Concourse Dr Ste 201Linthicum Heights, MD 21090-1033
Phone(919) 782-2152
Fax(919) 782-7929
Organization SubpartNo
Authorized OfficialAngela Ruth PetermanMd · (443) 351-3376
Enumeration DateMay 19, 2006
Last NPPES UpdateFebruary 14, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 14, 2025
✔ NPI 1568415586 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NC · 9900389
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
4201 LAKE BOONE TRL, Raleigh, NC 27607
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

CLIA Laboratory Certificates CMS CLIA

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 34D0240587

Southern Dermatology · Raleigh, NC
Active · expires Jun 1, 2027
CLIA Number34D0240587
Laboratory TypePhysician Office
Certificate Effective DateJune 2, 2025
Certificate Expiration DateJune 1, 2027
Laboratory DirectorGregory Wilmoth
Laboratory Phone(919) 782-2152
Laboratory LocationSouthern Dermatology4201 Lake Boone Trail, Suite 200, Raleigh, NC 27607
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 20

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

BIO-LIFECYCLE MEDICAL CENTERS, PLLC
Preventive Medicine (Public Health & General Preventive Medicine)
4201 LAKE BOONE TRL, STE 005
RALEIGH, NC 27607
Wake County (919) 851-9100
ANAM CARA WELLNESS PLLC
Psychiatry & Neurology (Psychiatry)
4201 LAKE BOONE TRL
RALEIGH, NC 27607
Wake County (984) 230-2416
GREGORY J WILMOTH M.D.
Dermatology (MOHS-Micrographic Surgery)
4201 LAKE BOONE TRL, SUITE 200
RALEIGH, NC 27607
Wake County (919) 782-2152
LINDSEY MCADAMS-PERRY LCSW
Social Worker (Clinical)
4201 LAKE BOONE TRL, STE 4
RALEIGH, NC 27607
Wake County (919) 781-4434
DR. ESTELLE CATHERINE TSALIK PT, DPT
Physical Therapist
4201 LAKE BOONE TRL, SUITE 4
RALEIGH, NC 27607
Wake County (919) 781-4434
MRS. JENNIFER H SPANGLER MS, CCC-SLP
Speech-Language Pathologist
4201 LAKE BOONE TRL, SUITE 4
RALEIGH, NC 27607
Wake County (919) 781-4434
DR. MARTHA FIELDS SIMPSON PHD
Psychologist
4201 LAKE BOONE TRL, SUITE 201
RALEIGH, NC 27607
Wake County (919) 785-0384
MISS BRITTANY D NORRIS M.S.
Speech-Language Pathologist
4201 LAKE BOONE TRL, SUITE 4
RALEIGH, NC 27607
Wake County (919) 781-4434

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Dermatology, P.A.'s NPI number?

The NPI number for Southern Dermatology, P.A. is 1568415586. It was assigned to this organization in the NPPES registry on May 19, 2006.

Where is Southern Dermatology, P.A. located?

Southern Dermatology, P.A. is located at 4201 Lake Boone Trl Suite 200, Raleigh, NC 27607. The listed phone number is (919) 782-2152.

What is Southern Dermatology, P.A.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Southern Dermatology, P.A. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 34D0240587) is associated with this NPI, valid through June 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southern Dermatology, P.A. accept?

Health plans from Blue Cross and Blue Shield of NC list Southern Dermatology, P.A. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southern Dermatology, P.A. was last updated on February 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.