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General NPI Number Information
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NPI Number | 1639254014
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Entity Type | Organization
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Legal Business Name | HILTON HEAD DERMATOLOGY AND SKIN CANCER CENTER PA
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 15 HOSPITAL CENTER BLVD STE 1
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City | HILTON HEAD
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State | SC
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Zip | 29926-2760
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Country | US
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Telephone | 843-689-9200
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Fax | 843-689-9201
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Provider Business Mailing Address
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Address Line | 15 HOSPITAL CENTER BLVD STE 1
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City | HILTON HEAD
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State | SC
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Zip | 29926-2760
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Country | US
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Telephone | 843-689-9200
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Fax | 843-689-9201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALBERT THOMAS BUNDY
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Credential | M.D.
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Telephone | 843-689-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | SC14710
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License Number State | SC
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