Provider Demographics
NPI:1184734543
Name:DERMATOLOGY ASSOCIATES OF NORTHEAST FLORIDA, PA
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF NORTHEAST FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHEIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-446-4466
Mailing Address - Street 1:8 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3808
Mailing Address - Country:US
Mailing Address - Phone:386-446-4466
Mailing Address - Fax:386-446-6066
Practice Address - Street 1:8 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3808
Practice Address - Country:US
Practice Address - Phone:386-446-4466
Practice Address - Fax:386-446-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
38799Medicare ID - Type Unspecified