MEDICARE: ADVANCED DERMATOLOGY & SKIN SURGERY SPECIALISTS PA

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	:	1558579284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DERMATOLOGY & SKIN SURGERY SPECIALISTS PA

Provider Business Mailing Address
First Line	:	1000 GOODLETTE RD N
Second Line	:	SUITE 100
City	:	NAPLES
State	:	FL
Zip	:	34102-5474
Country	:	US
Telephone Number	:	239-649-8384
Fax Number	:	239-643-0094

Provider Business Practice Location Address
First Line	:	1000 GOODLETTE RD N
Second Line	:	SUITE 100
City	:	NAPLES
State	:	FL
Zip	:	34102-5474
Country	:	US
Telephone Number	:	239-529-3376
Fax Number	:	239-643-0094

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	LINDA DEE GLAESER
Credential	:
Telephone Number	:	239-529-3376

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	04/26/2021

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