Healthcare Provider Details

I. General information

NPI: 1447186630
Provider Name (Legal Business Name): DERMATOLOGY OF PALM BEACH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 COLUMBIA DR # A101
WEST PALM BEACH FL
33409-1997
US

IV. Provider business mailing address

470 COLUMBIA DR # A101
WEST PALM BEACH FL
33409-1997
US

V. Phone/Fax

Practice location:
  • Phone: 561-594-2115
  • Fax: 888-761-8602
Mailing address:
  • Phone: 561-594-2115
  • Fax: 888-761-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA ROSENBERG
Title or Position: OWNER
Credential: MD
Phone: 561-594-2115