Provider Demographics
NPI:1336918408
Name:MEDICAL & SURGICAL DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:MEDICAL & SURGICAL DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEIDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-894-2473
Mailing Address - Street 1:52 HOSPITAL DR STE 3A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-8516
Mailing Address - Country:US
Mailing Address - Phone:828-894-2473
Mailing Address - Fax:828-894-2390
Practice Address - Street 1:2430 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3652
Practice Address - Country:US
Practice Address - Phone:904-664-8644
Practice Address - Fax:904-398-7048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL & SURGICAL DERMATOLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty