Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Intracoastal Dermatology and Skin Surgery PLLC

Organization Dermatology Physician · NPI 1871375055

Intracoastal Dermatology and Skin Surgery PLLC is a Dermatology Physician in Leland, North Carolina. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
4
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

509 Olde Waterford Way Ste 103
Leland, NC 28451-4126
Phone: (910) 631-0301
Fax: (910) 292-1230
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X
MOHS-Micrographic Surgery Physician Taxonomy 207ND0101X
Pediatric Dermatology Physician Taxonomy 207NP0225X
Procedural Dermatology Physician Taxonomy 207NS0135X

Record details

NPI number1871375055
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Blair Harris — Member/Organizer · (910) 631-0301
NPI enumeratedOctober 20, 2023
Last updated in NPPESApril 28, 2025
Certification dateApril 28, 2025
Mailing address509 Olde Waterford Way Ste 103, Leland, NC 28451-4126

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