Provider Demographics
NPI:1356300081
Name:DERMATOLOGY GROUP PA
Entity Type:Organization
Organization Name:DERMATOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-332-8080
Mailing Address - Street 1:515 W SR 434 STE 210
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5162
Mailing Address - Country:US
Mailing Address - Phone:407-332-8080
Mailing Address - Fax:352-383-7112
Practice Address - Street 1:2850 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6610
Practice Address - Country:US
Practice Address - Phone:352-383-0733
Practice Address - Fax:352-383-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99529Medicare PIN
FL99529AMedicare PIN