Provider Demographics
NPI:1669494621
Name:DIGITAL DERM, INC
Entity Type:Organization
Organization Name:DIGITAL DERM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-454-1295
Mailing Address - Street 1:1334 SUMTER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3324
Mailing Address - Country:US
Mailing Address - Phone:803-454-1295
Mailing Address - Fax:803-978-7456
Practice Address - Street 1:1334 SUMTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3324
Practice Address - Country:US
Practice Address - Phone:803-454-1295
Practice Address - Fax:803-978-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX I.D. NUMBER