Provider Demographics
NPI:1932831740
Name:GERMANTOWN DERMATOLOGY LLC
Entity Type:Organization
Organization Name:GERMANTOWN DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETRANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-579-7395
Mailing Address - Street 1:PO BOX 17346
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0346
Mailing Address - Country:US
Mailing Address - Phone:901-218-0055
Mailing Address - Fax:
Practice Address - Street 1:8000 WOLF RIVER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1756
Practice Address - Country:US
Practice Address - Phone:901-579-7395
Practice Address - Fax:901-425-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty