Provider Demographics
NPI:1295700722
Name:DERMATOLOGY OF LEXINGTON, LLC
Entity type:Organization
Organization Name:DERMATOLOGY OF LEXINGTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-951-1717
Mailing Address - Street 1:346 W. BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7342
Mailing Address - Country:US
Mailing Address - Phone:803-951-1717
Mailing Address - Fax:803-951-1878
Practice Address - Street 1:346 W. BUTLER STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7342
Practice Address - Country:US
Practice Address - Phone:803-951-1717
Practice Address - Fax:803-951-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4349Medicaid
SCAA09778421Medicare PIN