Healthcare Provider Details

I. General information

NPI: 1073556874
Provider Name (Legal Business Name): ATLANTIC SKIN & COSMETIC SURGERY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE RD SUITE 107; WEBSTER BUILDING
WILMINGTON DE
19810-4812
US

IV. Provider business mailing address

3411 SILVERSIDE RD SUITE 107; WEBSTER BUILDING
WILMINGTON DE
19810-4812
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-8532
  • Fax: 302-478-8536
Mailing address:
  • Phone: 302-478-4350
  • Fax: 302-478-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L SARUK
Title or Position: CHAIRMAN, CEO AND CHIEF MEDICAL OFF
Credential: M.D.
Phone: 302-478-4350