Provider Demographics
NPI:1043512502
Name:SKIN CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:SKIN CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVENS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEFLORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-489-6249
Mailing Address - Street 1:14959 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8613
Mailing Address - Country:US
Mailing Address - Phone:410-489-6249
Mailing Address - Fax:
Practice Address - Street 1:14959 OLD FREDERICK RD
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8613
Practice Address - Country:US
Practice Address - Phone:410-489-6249
Practice Address - Fax:206-350-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD09546208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty