Healthcare Provider Details

I. General information

NPI: 1477724961
Provider Name (Legal Business Name): OCEANSIDE DERMATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 BURNS RD SUITE 101
PALM BEACH GARDENS FL
33410-4328
US

IV. Provider business mailing address

3385 BURNS RD SUITE 101
PALM BEACH GARDENS FL
33410-4328
US

V. Phone/Fax

Practice location:
  • Phone: 561-371-0251
  • Fax: 561-493-8316
Mailing address:
  • Phone: 561-371-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME83379
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN BERNADETTE HERNE
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 561-371-0251