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

Southern Dermatology, PA

Organization Specialist · NPI 1568415586

Southern Dermatology, PA is a Specialist in Raleigh, North Carolina. Licensed in North Carolina. Registered with an NPI since 2006.

Licensed in
NC
In the registry since
2006
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4201 Lake Boone Trl Ste 200
Raleigh, NC 27607-7511
Phone: (919) 782-2152
Fax: (919) 782-7929
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 9900389 (NC)

Record details

NPI number1568415586
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Angela Peterman — Md · (443) 351-3376
NPI enumeratedMay 19, 2006
Last updated in NPPESFebruary 14, 2025
Certification dateFebruary 14, 2025
Mailing address1306 Concourse Dr Ste 201, Linthicum Heights, MD 21090-1033

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