Healthcare Provider Details

I. General information

NPI: 1427598580
Provider Name (Legal Business Name): DERMAHEAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CHARTWELL CT
MYRTLE BEACH SC
29588-7273
US

IV. Provider business mailing address

207 CHARTWELL CT
MYRTLE BEACH SC
29588-7273
US

V. Phone/Fax

Practice location:
  • Phone: 843-222-9038
  • Fax: 843-215-9756
Mailing address:
  • Phone: 843-222-9038
  • Fax: 843-215-9756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS CONSTANTINE MEXAS
Title or Position: DO/OWNER
Credential: DO
Phone: 843-222-9038