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WESTGATE DERMATOLOGY AND LASER CENTER, P.A.
NPI 1821240995
Dermatology - Dermatopathology in Winston Salem, NC

Active since October 21, 2008CLIA 34D2176944 · Waiver
2020 PEACE HAVEN RD, WINSTON SALEM, NC 27106(336) 768-1280 Get Directions Write a Review

NPPES record last updated: October 2, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Westgate Dermatology And Laser Center, P.a. NPPES

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

WESTGATE DERMATOLOGY AND LASER CENTER, P.A. (NPI 1821240995) is a healthcare organization registered as a dermatopathology in Winston Salem, North Carolina and active in the NPI registry since October 2008. The organization holds a CLIA Waiver certificate valid through December 29, 2027 and lists Paul J Kostuchenko, President, as its authorized official.

NPPES Registry Identity

NPI1821240995
Entity TypeOrganization
Primary Taxonomy207ND0900X
Legal Business NameWESTGATE DERMATOLOGY AND LASER CENTER, P.A.
Location Address2020 PEACE HAVEN RDWinston Salem, NC 27106-4851
Mailing Address2020 Peace Haven RdWinston Salem, NC 27106-4851 · (336) 768-1280
Phone(336) 768-1280
Organization SubpartNo
Authorized OfficialPaul J KostuchenkoPresident · (336) 768-1280
Enumeration DateOctober 21, 2008
Last NPPES UpdateOctober 2, 2012
✔ NPI 1821240995 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · DermatopathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ND0900X
Definition
A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.
2020 PEACE HAVEN RD, Winston Salem, NC 27106
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Other Identifiers 4

OtherQPB766NC · Sc Medicaid
MedicaidQPB766SC
Medicaid5950698NC
Medicare PIN2026585BNC

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

CLIA Laboratory Certificates CMS CLIA 2

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 Waiver 34D2176944

Westgate Dermatology And Laser Center, PA · Kernersville, NC
Active · expires Dec 29, 2027
CLIA Number34D2176944
Laboratory TypePhysician Office
Certificate Effective DateDecember 30, 2025
Certificate Expiration DateDecember 29, 2027
Laboratory DirectorPaul J. Kostuchenko
Laboratory Phone(336) 768-1280
Laboratory LocationWestgate Dermatology And Laser Center, PA280 Broad Street, Unit D, Kernersville, NC 27284
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 34D1094366

Westgate Dermatology And Laser Center, PA · Winston Salem, NC
Expired · Jul 31, 2026
CLIA Number34D1094366
Laboratory TypePhysician Office
Certificate Effective DateFebruary 17, 2024
Certificate Expiration DateJuly 31, 2026
Laboratory DirectorPaul J. Kostuchenko
Laboratory Phone(336) 768-1280
Laboratory LocationWestgate Dermatology And Laser Center, PA2020 Peace Haven Road, Winston Salem, NC 27106
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.

Other Providers at the Same Location NPPES

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

ALAN D KLEIN M.D.
Dermatology
2020 PEACE HAVEN RD
WINSTON SALEM, NC 27106
Forsyth County (336) 768-1280

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 Westgate Dermatology And Laser Center, P.A.'s NPI number?

The NPI number for Westgate Dermatology And Laser Center, P.A. is 1821240995. It was assigned to this organization in the NPPES registry on October 21, 2008.

Where is Westgate Dermatology And Laser Center, P.A. located?

Westgate Dermatology And Laser Center, P.A. is located at 2020 Peace Haven Rd, Winston Salem, NC 27106. The listed phone number is (336) 768-1280.

What is Westgate Dermatology And Laser Center, P.A.'s specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Dermatopathology, with taxonomy code 207ND0900X.

Does Westgate Dermatology And Laser Center, P.A. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2176944) is associated with this NPI, valid through December 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Westgate Dermatology And Laser Center, P.A. was last updated on October 2, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years 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.