Provider Demographics
NPI:1801362231
Name:INNOVA DERMATOLOGY PC
Entity Type:Organization
Organization Name:INNOVA DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:WING-YAN
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-266-3376
Mailing Address - Street 1:105 MAPLE ROW BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3853
Mailing Address - Country:US
Mailing Address - Phone:615-266-3376
Mailing Address - Fax:484-918-8506
Practice Address - Street 1:105 MAPLE ROW BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3853
Practice Address - Country:US
Practice Address - Phone:615-266-3376
Practice Address - Fax:484-918-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty