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General NPI Number Information
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NPI Number | 1497581821
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Entity Type | Organization
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Legal Business Name | DERM-360 LLC
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 319 E ANTIETAM ST
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5701
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Country | US
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Telephone | 540-560-3969
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Fax |
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Provider Business Mailing Address
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Address Line | 319 E ANTIETAM ST
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BHARATH BALU
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Credential | PHD MD
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Telephone | 540-560-3969
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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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