Provider Demographics
NPI:1861487795
Name:AMERICAN INSTITUTE OF DERMATOLOGY PA
Entity Type:Organization
Organization Name:AMERICAN INSTITUTE OF DERMATOLOGY PA
Other - Org Name:DARRIN A ROTMAN MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-386-0786
Mailing Address - Street 1:3109 MEDICAL WAY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5548
Mailing Address - Country:US
Mailing Address - Phone:863-386-0786
Mailing Address - Fax:863-386-1848
Practice Address - Street 1:3109 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5548
Practice Address - Country:US
Practice Address - Phone:863-386-0786
Practice Address - Fax:863-386-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2926Medicare ID - Type Unspecified