Provider Demographics
NPI:1497709067
Name:SPARTANBURG DERMATOLOGY & SKIN SURGERY CLINIC, PC
Entity Type:Organization
Organization Name:SPARTANBURG DERMATOLOGY & SKIN SURGERY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-582-3447
Mailing Address - Street 1:2020 N CHURCH STREET PL
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2706
Mailing Address - Country:US
Mailing Address - Phone:864-582-3447
Mailing Address - Fax:864-582-3449
Practice Address - Street 1:2020 N CHURCH STREET PL
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2706
Practice Address - Country:US
Practice Address - Phone:864-582-3447
Practice Address - Fax:864-582-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1574Medicare PIN