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General NPI Number Information
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NPI Number | 1861233827
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Entity Type | Organization
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Legal Business Name | GREEN DERMATOLOGY LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 310 MULLET RUN
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City | MILFORD
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State | DE
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Zip | 19963-5371
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Country | US
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Telephone | 302-459-5010
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Fax | 302-487-1727
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Provider Business Mailing Address
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Address Line | 310 MULLET RUN
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City | MILFORD
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State | DE
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Zip | 19963-5371
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Country | US
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Telephone | 302-459-5010
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Fax | 302-487-1727
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Authorized Official
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Title or Position | OWNER
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Name | DR. FADY GERGES
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Credential | MD
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Telephone | 302-459-5010
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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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