Provider Demographics
NPI:1225065741
Name:AMERICAN DERMATOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:AMERICAN DERMATOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-379-6647
Mailing Address - Street 1:5741 BEE RIDGE RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5064
Mailing Address - Country:US
Mailing Address - Phone:941-379-6647
Mailing Address - Fax:941-379-0611
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:SUITE 450
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-379-6647
Practice Address - Fax:941-379-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92484207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI 40224Medicare UPIN
FLK8183Medicare ID - Type Unspecified