MEDICARE: LUX DERMATOLOGY HAIR & SKIN INSTITUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1407558562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUX DERMATOLOGY HAIR & SKIN INSTITUTE LLC

Provider Business Mailing Address
First Line	:	4004 S MACDILL AVE STE 2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1551
Country	:	US
Telephone Number	:	813-709-8681
Fax Number	:	813-725-1611

Provider Business Practice Location Address
First Line	:	4004 S MACDILL AVE STE 2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1551
Country	:	US
Telephone Number	:	813-669-5455
Fax Number	:

Authorized Official
Title or Position	:	CEO/DERMATOLOGIST
Name	:	CHAUNCEY CALDWELL BARBULESCU
Credential	:	MD
Telephone Number	:	507-202-5713

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	04/08/2026

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