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PINEHURST DERMATOLOGY PA
NPI 1912002460
Specialist in Pinehurst, NC

Active since September 13, 2006CLIA 34D0245455 · Certificate of Compliance
120 BRAEMAR CT, PINEHURST, NC 28374(910) 295-5567(910) 295-3315 Get Directions Write a Review

NPPES record last updated: July 14, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Pinehurst Dermatology Pa NPPES

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

PINEHURST DERMATOLOGY PA (NPI 1912002460) is a healthcare organization registered as a specialist in Pinehurst, North Carolina and active in the NPI registry since September 2006. The organization holds a CLIA Certificate of Compliance certificate valid through August 29, 2027 and lists Vickie F Millenbaugh, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1912002460
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NamePINEHURST DERMATOLOGY PA
Location Address120 BRAEMAR CTPinehurst, NC 28374-8747
Mailing Address120 Braemar CtPinehurst, NC 28374-8747 · (910) 295-5567 · Fax (910) 295-3315
Phone(910) 295-5567
Fax(910) 295-3315
Organization SubpartNo
Authorized OfficialVickie F MillenbaughOffice Manager · (910) 295-8748
Enumeration DateSeptember 13, 2006
Last NPPES UpdateJuly 14, 2020
NPPES CertifiedJuly 14, 2020
✔ NPI 1912002460 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
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.
120 BRAEMAR CT, Pinehurst, NC 28374
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Other Identifiers 2

Other02423NC · Blue Cross
Medicaid8902423NC

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

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 34D0245455

Pinehurst Dermatology And Mohs Surgery Center · Pinehurst, NC
Active · expires Aug 29, 2027
CLIA Number34D0245455
Laboratory TypePhysician Office
Certificate Effective DateAugust 30, 2025
Certificate Expiration DateAugust 29, 2027
Laboratory DirectorKevin Y. Shi
Laboratory Phone(910) 295-5567
Laboratory LocationPinehurst Dermatology And Mohs Surgery Center5 Regional Circle Suite B, Pinehurst, NC 28374
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 8

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

NARIAH FOY PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 562-9882
MRS. DAWN MARIE ADAMS PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 562-9882
CHRISTI CONLEY LMFT
Marriage & Family Therapist
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 562-9882
SANDHILLS BEHAVIORAL CARE, PLLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 562-9882
ERICA LEE CHEEK LCSWA
Social Worker (Clinical)
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 562-9882
STEPHEN SCOTT CLINE
Social Worker (Clinical)
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 562-9882
ELENA M AVILA PA
Physician Assistant (Medical)
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 295-5567
MR. JOEMEL JAY MEDIAVILLA BALOYO PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
120 BRAEMAR CT
PINEHURST, NC 28374
Moore County (910) 562-9882

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 Pinehurst Dermatology PA's NPI number?

The NPI number for Pinehurst Dermatology PA is 1912002460. It was assigned to this organization in the NPPES registry on September 13, 2006.

Where is Pinehurst Dermatology PA located?

Pinehurst Dermatology PA is located at 120 Braemar Ct, Pinehurst, NC 28374. The listed phone number is (910) 295-5567.

What is Pinehurst Dermatology PA's specialty?

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

Does Pinehurst Dermatology PA hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 34D0245455) is associated with this NPI, valid through August 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 Pinehurst Dermatology PA was last updated on July 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.