Provider Demographics
NPI:1467907105
Name:GROUP M DERMATOLOGY PA
Entity Type:Organization
Organization Name:GROUP M DERMATOLOGY PA
Other - Org Name:JUPITER DERMATOLOGY & HAIR RESTORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-748-0510
Mailing Address - Street 1:PO BOX 749539
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9539
Mailing Address - Country:US
Mailing Address - Phone:561-748-0510
Mailing Address - Fax:561-748-0598
Practice Address - Street 1:2101 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-7321
Practice Address - Country:US
Practice Address - Phone:561-748-0510
Practice Address - Fax:561-748-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty