Provider Demographics
NPI:1508256660
Name:DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES
Other - Org Name:GEORGE P. PAVLIDAKEY, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PAVLIDAKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-446-6217
Mailing Address - Street 1:609 INDIAN ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2056
Mailing Address - Country:US
Mailing Address - Phone:727-446-6217
Mailing Address - Fax:727-442-4712
Practice Address - Street 1:609 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-2056
Practice Address - Country:US
Practice Address - Phone:727-446-6217
Practice Address - Fax:727-442-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39860207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62643Medicare PIN
FLD65395Medicare UPIN