Provider Demographics
NPI:1982308508
Name:REFORME DERMATOLOGY AND AESTHETICS, LLC
Entity Type:Organization
Organization Name:REFORME DERMATOLOGY AND AESTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASILE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-893-2411
Mailing Address - Street 1:2265 TILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9505
Mailing Address - Country:US
Mailing Address - Phone:302-893-2411
Mailing Address - Fax:
Practice Address - Street 1:302 WINGO WAY STE 303
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2839
Practice Address - Country:US
Practice Address - Phone:843-974-1230
Practice Address - Fax:843-974-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty