Healthcare Provider Details

I. General information

NPI: 1467507566
Provider Name (Legal Business Name): CENTER FOR DERMATOLOGY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BEISER BLVD SUITE 201
DOVER DE
19904-7793
US

IV. Provider business mailing address

230 BEISER BLVD SUITE 201
DOVER DE
19904-7793
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-1273
  • Fax: 302-677-1278
Mailing address:
  • Phone: 302-677-1273
  • Fax: 302-677-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC10006521
License Number StateDE

VIII. Authorized Official

Name: LINDSAY BRATHWAITE
Title or Position: PROVIDER
Credential: M.D.
Phone: 302-677-1273