Provider Demographics
NPI:1952524126
Name:NORTH COUNTY DERMATOLOGY CLINIC PA
Entity Type:Organization
Organization Name:NORTH COUNTY DERMATOLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-853-3331
Mailing Address - Street 1:6500 N SOCRUM LOOP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4179
Mailing Address - Country:US
Mailing Address - Phone:863-853-3331
Mailing Address - Fax:863-853-3337
Practice Address - Street 1:6500 N SOCRUM LOOP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4179
Practice Address - Country:US
Practice Address - Phone:863-853-3331
Practice Address - Fax:863-853-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03-00964OtherUNITED HEALTH CARE
FL7988417OtherAETNA TRADITIONAL
FL62853OtherBCBS
FL08166OtherUNIVERSAL
FL1716600OtherAETNA HMO
FL2122854621301OtherBEECHSTREET
FLDG5508OtherRAILROAD MEDICARE GROUP
FLP0044110OtherRAILROAD INDIVIDUAL
FL490487144OtherTRICARE
FL11246701OtherCITRUS
FL265978600Medicaid
FL62853OtherBCBS
FLP0044110OtherRAILROAD INDIVIDUAL
FLAF582Medicare PIN