Provider Demographics
NPI:1043453970
Name:WASSERMAN, JUSTIN ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROSS
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 AVENIDA DEL CIRCO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4108
Mailing Address - Country:US
Mailing Address - Phone:941-484-8222
Mailing Address - Fax:941-486-3016
Practice Address - Street 1:1111 AVENIDA DEL CIRCO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4108
Practice Address - Country:US
Practice Address - Phone:941-484-8222
Practice Address - Fax:941-486-3016
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122668207N00000X, 207ND0900X
FLME106806207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology