MEDICARE: CENTER FOR DERMATOLOGY 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
1	207ND0101X	MOHS-Micrographic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689693558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR DERMATOLOGY PA

Provider Business Mailing Address
First Line	:	1480 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6040
Country	:	US
Telephone Number	:	954-753-1030
Fax Number	:	954-753-1115

Provider Business Practice Location Address
First Line	:	1480 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6040
Country	:	US
Telephone Number	:	954-753-1030
Fax Number	:	954-753-1115

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BONNIE POLLACK
Credential	:
Telephone Number	:	954-753-1030

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/05/2010

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Directions to “CENTER FOR DERMATOLOGY PA ” Practice Location

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