INTRACOASTAL DERMATOLOGY AND SKIN SURGERY PLLC
NPI 1871375055
Dermatology in Leland, NC

Active since October 20, 2023CLIA 34D2307849 · Certificate of Compliance
509 OLDE WATERFORD WAY STE 103, LELAND, NC 28451(910) 631-0301(910) 292-1230 Get Directions Write a Review

NPPES record last updated: April 28, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 28, 2024, Oct 25, 2023, Oct 20, 2023 (3 updates tracked since 2023).

About Intracoastal Dermatology And Skin Surgery Pllc NPPES

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

INTRACOASTAL DERMATOLOGY AND SKIN SURGERY PLLC (NPI 1871375055) is a healthcare organization registered as a dermatology in Leland, North Carolina and active in the NPI registry since October 2023. The organization holds a CLIA Certificate of Compliance certificate valid through May 13, 2027 and lists Blair Harris, Member/organizer, as its authorized official.

NPPES Registry Identity

NPI1871375055
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameINTRACOASTAL DERMATOLOGY AND SKIN SURGERY PLLC
Location Address509 OLDE WATERFORD WAY STE 103Leland, NC 28451-4126
Mailing Address509 Olde Waterford Way Ste 103Leland, NC 28451-4126
Fax(910) 292-1230
Organization SubpartNo
Authorized OfficialBlair HarrisMember/organizer · (910) 631-0301
Enumeration DateOctober 20, 2023
Last NPPES UpdateApril 28, 20253 updates tracked since enumeration
NPPES CertifiedApril 28, 2025
NPI 1871375055 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · Pediatric DermatologyTaxonomy 207NP0225X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
509 OLDE WATERFORD WAY STE 103, Leland, NC 28451

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

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 34D2307849

Intracoastal Dermatology And Skin Surgery PLLC · Leland, NC
Active · expires May 13, 2027
CLIA Number34D2307849
Laboratory TypePhysician Office
Certificate Effective DateMay 14, 2025
Certificate Expiration DateMay 13, 2027
Laboratory DirectorDr. Blair W. Harris
Laboratory Phone(910) 631-0301
Laboratory LocationIntracoastal Dermatology And Skin Surgery PLLC509 Olde Waterford Way, Ste 103, Leland, NC 28451
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 2

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

Dermatology
509 OLDE WATERFORD WAY STE 103
LELAND, NC 28451
Physician Assistant
509 OLDE WATERFORD WAY STE 103
LELAND, NC 28451

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 Intracoastal Dermatology And Skin Surgery PLLC's NPI number?

The NPI number for Intracoastal Dermatology And Skin Surgery PLLC is 1871375055. It was assigned to this organization in the NPPES registry on October 20, 2023.

Where is Intracoastal Dermatology And Skin Surgery PLLC located?

Intracoastal Dermatology And Skin Surgery PLLC is located at 509 Olde Waterford Way Ste 103, Leland, NC 28451. The listed phone number is (910) 631-0301.

What is Intracoastal Dermatology And Skin Surgery PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Intracoastal Dermatology And Skin Surgery PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 34D2307849) is associated with this NPI, valid through May 13, 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 Intracoastal Dermatology And Skin Surgery PLLC was last updated on April 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.