Provider Demographics
NPI:1982877221
Name:ASH DERMATOLOGY & SKIN CANCER CENTER, PA
Entity Type:Organization
Organization Name:ASH DERMATOLOGY & SKIN CANCER CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-986-9335
Mailing Address - Street 1:190 S SYKES CREEK PKWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3572
Mailing Address - Country:US
Mailing Address - Phone:321-986-9335
Mailing Address - Fax:321-986-9337
Practice Address - Street 1:190 S SYKES CREEK PKWY
Practice Address - Street 2:SUITE 3
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3572
Practice Address - Country:US
Practice Address - Phone:321-986-9335
Practice Address - Fax:321-986-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 83012207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5627Medicare PIN