Provider Demographics
NPI:1932553245
Name:SAUL DERMATOLOGY PA
Entity Type:Organization
Organization Name:SAUL DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-512-0500
Mailing Address - Street 1:5002 HIGHWAY 39 N BLDG A
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1078
Mailing Address - Country:US
Mailing Address - Phone:601-512-0500
Mailing Address - Fax:601-512-0505
Practice Address - Street 1:5002 HIGHWAY 39 N BLDG A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1078
Practice Address - Country:US
Practice Address - Phone:601-512-0500
Practice Address - Fax:601-512-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22764261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS73025117OtherBLUE CROSS OF ALABAMA
MS73025117OtherBLUE CROSS OF ALABAMA
MS497602Medicare PIN