Provider Demographics
NPI:1568236032
Name:EXCLUSIVE DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:EXCLUSIVE DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-561-7546
Mailing Address - Street 1:112 VIA VERDE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6205
Mailing Address - Country:US
Mailing Address - Phone:301-807-4000
Mailing Address - Fax:
Practice Address - Street 1:500 S AUSTRALIAN AVE STE 205
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6235
Practice Address - Country:US
Practice Address - Phone:561-561-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty