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NPI Code Detail

MEDICARE: SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA

MEDICARE: SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, 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
1207ND0101XMOHS-Micrographic Surgery Physician
2207ND0900XDermatopathology Physician
3207NS0135XProcedural Dermatology Physician
4207N00000XDermatology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CA6816OTHERFLSRRGA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902890239
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA
Provider Business Mailing Address
First Line : 525 N DACIE PT
Second Line :
City : LECANTO
State : FL
Zip : 34461-8399
Country : US
Telephone Number : 352-746-2200
Fax Number : 352-746-9320
Provider Business Practice Location Address
First Line : 525 N DACIE PT
Second Line :
City : LECANTO
State : FL
Zip : 34461-8399
Country : US
Telephone Number : 352-746-2200
Fax Number : 352-746-9320
Authorized Official
Title or Position : PRESIDENT
Name : DR. RALPH EUGENE MASSULLO JR.
Credential : MD
Telephone Number : 352-746-2200
Provider Enumeration Date : 09/01/2005
Last Update Date : 11/15/2011

Similar Medicare Providers

1376772707 — DR. BRETT PATRICK BLAKE M.D.
Practice Location Address:
525 N DACIE PT
LECANTO, FL
34461-8399
Practice Phone: 813-321-1786
Practice Fax: 813-321-1787
1073507455 — DR. MARGARET ANNE COLLINS MD
Practice Location Address:
525 N DACIE PT
LECANTO, FL
34461-8399
Practice Phone: 352-746-2200
Practice Fax: 352-746-9320
1104810563 — DR. RALPH EUGENE MASSULLO JR. MD
Practice Location Address:
525 N DACIE PT
LECANTO, FL
34461-8399
Practice Phone: 352-746-2200
Practice Fax: 352-746-9320
1124012596 — MR. BRIAN KEITH BONOMO PAC
Practice Location Address:
525 N DACIE PT
LECANTO, FL
34461-8399
Practice Phone: 352-746-2200
Practice Fax: 352-746-9320
1043204365 — DR. WILLIAM ARCH WELTON III MD
Practice Location Address:
525 N DACIE PT
LECANTO, FL
34461-8399
Practice Phone: 352-746-2200
Practice Fax: 352-746-9320
1396794103 — ELIZABETH M ESTES ARNP
Practice Location Address:
525 N DACIE PT
LECANTO, FL
34461-8399
Practice Phone: 352-746-2200
Practice Fax: 352-746-9320

Directions to “SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA ” Practice Location

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