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General NPI Number Information
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NPI Number | 1831026004
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Entity Type | Organization
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Legal Business Name | BW DERMATOLOGY PLLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 2339 MEDICO LN STE 101
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City | MELBOURNE
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State | FL
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Zip | 32940-8946
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Country | US
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Telephone | 321-406-8615
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Fax |
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Provider Business Mailing Address
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Address Line | 2339 MEDICO LN STE 101
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City | MELBOURNE
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State | FL
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Zip | 32940-8946
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Country | US
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Telephone | 321-406-8615
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANDREW KELSEY
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Credential | MD
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Telephone | 321-406-8615
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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