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NPI Code Detail

MEDICARE: DERMATOLOGY GROUP PA

MEDICARE: DERMATOLOGY GROUP PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1356300081
Entity Type Code : Organization
Provider Name (Legal Business Name) : DERMATOLOGY GROUP PA
Provider Business Mailing Address
First Line : 515 W SR 434 STE 210
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-5162
Country : US
Telephone Number : 407-332-8080
Fax Number : 352-383-7112
Provider Business Practice Location Address
First Line : 2850 MORNINGSIDE DR
Second Line :
City : MOUNT DORA
State : FL
Zip : 32757-6610
Country : US
Telephone Number : 352-383-0733
Fax Number : 352-383-7112
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. ERIN HOWARD
Credential :
Telephone Number : 407-332-8080
Provider Enumeration Date : 03/21/2006
Last Update Date : 07/26/2023

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