Provider Demographics
NPI:1538546262
Name:SKIN CANCER EB, LLC
Entity type:Organization
Organization Name:SKIN CANCER EB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:IOFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-591-6910
Mailing Address - Street 1:1903 CORBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-2027
Mailing Address - Country:US
Mailing Address - Phone:410-591-6910
Mailing Address - Fax:
Practice Address - Street 1:300 REDLAND CT
Practice Address - Street 2:SUITE 101
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3271
Practice Address - Country:US
Practice Address - Phone:410-591-6910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD638352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty