Provider Demographics
NPI:1134360357
Name:EAST COAST DERMATOLOGY
Entity type:Organization
Organization Name:EAST COAST DERMATOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLADAY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:843-614-2884
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3261
Mailing Address - Country:US
Mailing Address - Phone:843-971-7546
Mailing Address - Fax:843-971-3376
Practice Address - Street 1:1300 HOSPITAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3261
Practice Address - Country:US
Practice Address - Phone:843-614-2884
Practice Address - Fax:843-614-2884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST COAST PRACTICE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-18
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty