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General NPI Number Information
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NPI Number | 1306399860
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Entity Type | Organization
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Legal Business Name | UPSTATE DERMATOLOGY PA
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Dates
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Enumeration Date | 08/01/2016
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 310 THE PKWY
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City | GREER
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State | SC
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Zip | 29650-4569
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Country | US
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Telephone | 864-877-0776
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Fax | 864-877-0778
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Provider Business Mailing Address
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Address Line | 310 THE PKWY
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City | GREER
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State | SC
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Zip | 29650-4569
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Country | US
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Telephone | 864-877-0776
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Fax | 864-877-0778
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Authorized Official
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Title or Position | OWNER
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Name | JOHN KORMAN
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Credential | MD
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Telephone | 864-877-0776
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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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