Provider Demographics
NPI:1124314356
Name:NATIONAL DERMATOLOGY HEALTHCARE, LLC
Entity type:Organization
Organization Name:NATIONAL DERMATOLOGY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH, MBA
Authorized Official - Phone:813-880-7546
Mailing Address - Street 1:8002 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1603
Mailing Address - Country:US
Mailing Address - Phone:813-886-7613
Mailing Address - Fax:813-792-7895
Practice Address - Street 1:8002 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1603
Practice Address - Country:US
Practice Address - Phone:813-886-7613
Practice Address - Fax:813-792-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL054442207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB96434Medicare UPIN