Provider Demographics
NPI:1578173936
Name:MILL VALLEY DERMATOLOGY, INC
Entity Type:Organization
Organization Name:MILL VALLEY DERMATOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-634-8411
Mailing Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3031
Mailing Address - Country:US
Mailing Address - Phone:415-634-8411
Mailing Address - Fax:844-880-4434
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3031
Practice Address - Country:US
Practice Address - Phone:415-634-8411
Practice Address - Fax:844-880-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty