Provider Demographics
NPI:1558579284
Name:ADVANCED DERMATOLOGY & SKIN SURGERY SPECIALISTS PA
Entity Type:Organization
Organization Name:ADVANCED DERMATOLOGY & SKIN SURGERY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:GLAESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-529-3376
Mailing Address - Street 1:1000 GOODLETTE RD N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5474
Mailing Address - Country:US
Mailing Address - Phone:239-649-8384
Mailing Address - Fax:239-643-0094
Practice Address - Street 1:1000 GOODLETTE RD N
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5474
Practice Address - Country:US
Practice Address - Phone:239-529-3376
Practice Address - Fax:239-643-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME71468Medicare ID - Type Unspecified