Provider Demographics
NPI:1033686928
Name:DERRINGTON DERMATOLOGY, PA
Entity Type:Organization
Organization Name:DERRINGTON DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-459-8400
Mailing Address - Street 1:9217 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE C1B
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9147
Mailing Address - Country:US
Mailing Address - Phone:843-459-8400
Mailing Address - Fax:483-459-8401
Practice Address - Street 1:9217 UNIVERSITY BLVD
Practice Address - Street 2:SUITE C1B
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9147
Practice Address - Country:US
Practice Address - Phone:843-459-8400
Practice Address - Fax:843-459-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891106811OtherINDIVIDUAL NPI
SC52172OtherMEDICAL LICENSE