Provider Demographics
NPI:1952069965
Name:DERM MD LLC
Entity Type:Organization
Organization Name:DERM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASHAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:CLEMETSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-648-1616
Mailing Address - Street 1:2964 N STATE ROAD 7 STE 200
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:817-612-3586
Practice Address - Street 1:2964 N STATE ROAD 7 STE 200
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5715
Practice Address - Country:US
Practice Address - Phone:954-648-1616
Practice Address - Fax:817-612-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty