Provider Demographics
NPI:1508983131
Name:DERMATOLOGY CENTRES-TREASURE COAST P A
Entity Type:Organization
Organization Name:DERMATOLOGY CENTRES-TREASURE COAST P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-637-0222
Mailing Address - Street 1:5130 LINTON BLVD
Mailing Address - Street 2:SUITE C4-5
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-637-0222
Mailing Address - Fax:561-637-8219
Practice Address - Street 1:528 SE OSCEOLA ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2366
Practice Address - Country:US
Practice Address - Phone:772-287-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40818Medicare ID - Type UnspecifiedGROUP NUMBER