Provider Demographics
NPI:1851779144
Name:SOUTHCOAST DERMALGRAPHICS, LLC
Entity Type:Organization
Organization Name:SOUTHCOAST DERMALGRAPHICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-789-5104
Mailing Address - Street 1:PO BOX 30165
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-0165
Mailing Address - Country:US
Mailing Address - Phone:508-817-7026
Mailing Address - Fax:
Practice Address - Street 1:192 B SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743
Practice Address - Country:US
Practice Address - Phone:508-817-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Single Specialty