MEDICARE: ASH DERMATOLOGY & SKIN CANCER 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
1	207N00000X	Dermatology Physician	ME 83012	FL

General Provider Information

NPI Number	:	1982877221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASH DERMATOLOGY & SKIN CANCER CENTER, PA

Provider Business Mailing Address
First Line	:	190 S SYKES CREEK PKWY
Second Line	:	SUITE 3
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3572
Country	:	US
Telephone Number	:	321-986-9335
Fax Number	:	321-986-9337

Provider Business Practice Location Address
First Line	:	190 S SYKES CREEK PKWY
Second Line	:	SUITE 3
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-3572
Country	:	US
Telephone Number	:	321-986-9335
Fax Number	:	321-986-9337

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARBARA ANNE ASH
Credential	:	M.D.
Telephone Number	:	321-986-9335

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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