Organization
CRYSTAL COAST DERMATOLOGY SERVICES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EARL GEORGE GROSS M.D. (PRESIDENT)
(252) 808-3376
Entity
Organization
Contact information
Practice address
3610 MEDICAL PARK COURT, MOREHEAD CITY, NC 28557
(252) 808-3376
(252) 808-2095
Mailing address
PO BOX 927, MOREHEAD CITY, NC 28557-0927
(252) 808-3376
(252) 808-2095
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
99-00855
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011A5
BLUE CROSS OF NC
NC
05
—
89011A5
—
NC
Enumeration date
01/23/2007
Last updated
08/22/2020
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