Provider Demographics
NPI:1043888985
Name:MAGNIFYDX LLC
Entity Type:Organization
Organization Name:MAGNIFYDX LLC
Other - Org Name:DERMAGNIFY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-624-3376
Mailing Address - Street 1:100 EXECUTIVE WAY STE 114
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2713
Mailing Address - Country:US
Mailing Address - Phone:904-842-3632
Mailing Address - Fax:904-686-7771
Practice Address - Street 1:100 EXECUTIVE WAY STE 114
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2713
Practice Address - Country:US
Practice Address - Phone:904-842-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty