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General NPI Number Information
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NPI Number | 1134617533
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND SKIN CANCER SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 7560 RED BUG LAKE RD STE 1014
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City | OVIEDO
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State | FL
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Zip | 32765-6591
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Country | US
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Telephone | 407-706-1770
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Fax | 407-706-1777
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Provider Business Mailing Address
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Address Line | 7560 RED BUG LAKE RD STE 1014
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City | OVIEDO
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State | FL
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Zip | 32765-6591
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Country | US
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Telephone | 407-706-1770
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Fax | 407-706-1777
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | VITALY BLATNOY
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Credential | MD
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Telephone | 407-446-8312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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