Provider Demographics
NPI:1467520775
Name:DERMATOLOGY & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:DERMATOLOGY & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FLETCHER
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-776-2544
Mailing Address - Street 1:PO BOX 11366
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-4366
Mailing Address - Country:US
Mailing Address - Phone:340-776-2544
Mailing Address - Fax:340-774-2677
Practice Address - Street 1:9150 ESTATE THOMAS
Practice Address - Street 2:SUITE 106
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2612
Practice Address - Country:US
Practice Address - Phone:340-776-2544
Practice Address - Fax:340-774-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0096367Medicare PIN