Organization
INTRACOASTAL DERMATOLOGY AND SKIN SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAIR HARRIS DO (MEMBER/ORGANIZER)
(910) 631-0301
Entity
Organization
Contact information
Practice address
509 OLDE WATERFORD WAY STE 103, LELAND, NC 28451-4126
(910) 631-0301
(910) 292-1230
Mailing address
509 OLDE WATERFORD WAY STE 103, LELAND, NC 28451-4126
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
10/20/2023
Last updated
04/28/2025
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