MEDICARE: BW DERMATOLOGY PLLC

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	207N00000X	Dermatology Physician
2	207ND0101X	MOHS-Micrographic Surgery Physician

General Provider Information

NPI Number	:	1831026004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BW DERMATOLOGY PLLC

Provider Business Mailing Address
First Line	:	2339 MEDICO LN STE 101
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8946
Country	:	US
Telephone Number	:	321-406-8615
Fax Number	:

Provider Business Practice Location Address
First Line	:	2339 MEDICO LN STE 101
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8946
Country	:	US
Telephone Number	:	321-406-8615
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANDREW KELSEY
Credential	:	MD
Telephone Number	:	321-406-8615

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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