Provider Demographics
NPI:1215354683
Name:SEACOAST DERMATOLOGY PLLC
Entity type:Organization
Organization Name:SEACOAST DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DINULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-363-9678
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-431-5205
Mailing Address - Fax:603-436-4257
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-431-5205
Practice Address - Fax:603-436-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10990207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty