Provider Demographics
NPI:1922439710
Name:LAURA E. SKELLCHOCK MD PA
Entity Type:Organization
Organization Name:LAURA E. SKELLCHOCK MD PA
Other - Org Name:INTEGRATIVE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SKELLCHOCK MD PA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-488-2689
Mailing Address - Street 1:6100 GLADES RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4325
Mailing Address - Country:US
Mailing Address - Phone:561-488-2689
Mailing Address - Fax:561-353-4132
Practice Address - Street 1:6100 GLADES RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4325
Practice Address - Country:US
Practice Address - Phone:561-488-2689
Practice Address - Fax:561-353-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88323207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty