Provider Demographics
NPI:1427712439
Name:MY DERMATOLOGY & COSMETIC CENTER LLC
Entity type:Organization
Organization Name:MY DERMATOLOGY & COSMETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HART
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-340-9039
Mailing Address - Street 1:818 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5642
Mailing Address - Country:US
Mailing Address - Phone:727-295-7223
Mailing Address - Fax:727-325-1060
Practice Address - Street 1:818 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5642
Practice Address - Country:US
Practice Address - Phone:727-295-7223
Practice Address - Fax:727-325-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty