Provider Demographics
NPI:1851645253
Name:DERMATOLOGY SURGICAL AND MEDICAL, APC
Entity Type:Organization
Organization Name:DERMATOLOGY SURGICAL AND MEDICAL, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-353-7247
Mailing Address - Street 1:2881 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6207
Mailing Address - Country:US
Mailing Address - Phone:619-291-8292
Mailing Address - Fax:619-291-8229
Practice Address - Street 1:2881 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6207
Practice Address - Country:US
Practice Address - Phone:619-291-8292
Practice Address - Fax:619-291-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG886298207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty