Healthcare Provider Details

I. General information

NPI: 1720005770
Provider Name (Legal Business Name): DERMATOLOGICAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WEBER HILL RD STE 200
SAINT LOUIS MO
63127-1569
US

IV. Provider business mailing address

10004 KENNERLY RD 395B
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-5660
  • Fax: 314-842-0169
Mailing address:
  • Phone: 314-842-5660
  • Fax: 314-842-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34703
License Number StateMO

VIII. Authorized Official

Name: NANCY MARCHI
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-842-5660