Provider Demographics
NPI:1770949398
Name:HENDERSONVILLE DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:HENDERSONVILLE DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-697-1170
Mailing Address - Street 1:15 MARKET CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-8529
Mailing Address - Country:US
Mailing Address - Phone:828-697-1170
Mailing Address - Fax:828-698-4939
Practice Address - Street 1:15 MARKET CENTER DR
Practice Address - Street 2:STE A
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-8528
Practice Address - Country:US
Practice Address - Phone:828-697-1170
Practice Address - Fax:828-698-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33967207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDW3295OtherRAILROAD MEDICARE
NCF459OtherMEDICARE