Healthcare Provider Details

I. General information

NPI: 1225918220
Provider Name (Legal Business Name): RM DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK AVE
NEW YORK NY
10021-0104
US

IV. Provider business mailing address

200 E 66TH ST APT E507
NEW YORK NY
10065-9192
US

V. Phone/Fax

Practice location:
  • Phone: 212-517-6555
  • Fax:
Mailing address:
  • Phone: 202-306-2472
  • 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 Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RADHA MIKKILINENI
Title or Position: MEMBER
Credential: MD
Phone: 202-306-2472