MEDICARE: THE DERM GROUP, LLP

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

Other Identifiers

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

General Provider Information

NPI Number	:	1962100701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DERM GROUP, LLP

Provider Business Mailing Address
First Line	:	11924 FOREST HILL BLVD STE 10A-411
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6256
Country	:	US
Telephone Number	:	561-425-2929
Fax Number	:	561-810-1677

Provider Business Practice Location Address
First Line	:	7150 W 20TH AVE STE 210
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5531
Country	:	US
Telephone Number	:	305-828-7504
Fax Number	:	305-828-7506

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THEODORE JOHN GIUFFRIDA
Credential	:	MD
Telephone Number	:	305-461-2000

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	04/05/2023

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