Provider Demographics
NPI:1447420070
Name:ROCK HILL DERMATOLOGY CENTER
Entity Type:Organization
Organization Name:ROCK HILL DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OZ
Authorized Official - Middle Name:
Authorized Official - Last Name:IDLIBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-393-3710
Mailing Address - Street 1:1533 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1806
Mailing Address - Country:US
Mailing Address - Phone:803-328-1831
Mailing Address - Fax:803-324-5131
Practice Address - Street 1:1533 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1806
Practice Address - Country:US
Practice Address - Phone:803-328-1831
Practice Address - Fax:803-328-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC06954174400000X
207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty