MEDICARE: RESTORATION DERMATOLOGY PLC

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	207ND0101X	MOHS-Micrographic Surgery Physician

General Provider Information

NPI Number	:	1417698549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION DERMATOLOGY PLC

Provider Business Mailing Address
First Line	:	3803 BEDFORD AVE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2565
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3803 BEDFORD AVE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2565
Country	:	US
Telephone Number	:	615-249-4700
Fax Number	:

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. VINEET MISHRA
Credential	:	MD
Telephone Number	:	615-305-0658

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/14/2023

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