Provider Demographics
NPI:1073556874
Name:ATLANTIC SKIN & COSMETIC SURGERY GROUP, P.C.
Entity Type:Organization
Organization Name:ATLANTIC SKIN & COSMETIC SURGERY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, CEO AND CHIEF MEDICAL OFF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SARUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-4350
Mailing Address - Street 1:3411 SILVERSIDE RD
Mailing Address - Street 2:SUITE 107; WEBSTER BUILDING
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4812
Mailing Address - Country:US
Mailing Address - Phone:302-478-4350
Mailing Address - Fax:302-478-4325
Practice Address - Street 1:3411 SILVERSIDE RD
Practice Address - Street 2:SUITE 107; WEBSTER BUILDING
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4812
Practice Address - Country:US
Practice Address - Phone:302-478-8532
Practice Address - Fax:302-478-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00546Medicare PIN
PA047822Medicare PIN