Healthcare Provider Details

I. General information

NPI: 1033964374
Provider Name (Legal Business Name): COLLO ROSSO DERMATOLOGY, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLARK ST
CHAPIN SC
29036-8633
US

IV. Provider business mailing address

306 LEXINGTON AVE
CHAPIN SC
29036-8086
US

V. Phone/Fax

Practice location:
  • Phone: 803-233-8668
  • Fax: 619-367-0403
Mailing address:
  • Phone: 803-233-8668
  • Fax: 619-367-0403

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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CURTIS LAMAR HARDY
Title or Position: CEO
Credential: DO
Phone: 803-233-8668