MEDICARE: DERMAHEAL, LLC

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
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1427598580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMAHEAL, LLC

Provider Business Mailing Address
First Line	:	207 CHARTWELL CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7273
Country	:	US
Telephone Number	:	843-222-9038
Fax Number	:	843-215-9756

Provider Business Practice Location Address
First Line	:	207 CHARTWELL CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7273
Country	:	US
Telephone Number	:	843-222-9038
Fax Number	:	843-215-9756

Authorized Official
Title or Position	:	DO/OWNER
Name	:	NICHOLAS CONSTANTINE MEXAS
Credential	:	DO
Telephone Number	:	843-222-9038

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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Directions to “DERMAHEAL, LLC ” Practice Location

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