Provider Demographics
NPI:1427598580
Name:DERMAHEAL, LLC
Entity Type:Organization
Organization Name:DERMAHEAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CONSTANTINE
Authorized Official - Last Name:MEXAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-222-9038
Mailing Address - Street 1:207 CHARTWELL CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7273
Mailing Address - Country:US
Mailing Address - Phone:843-222-9038
Mailing Address - Fax:843-215-9756
Practice Address - Street 1:207 CHARTWELL CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7273
Practice Address - Country:US
Practice Address - Phone:843-222-9038
Practice Address - Fax:843-215-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty