Provider Demographics
NPI:1538718622
Name:ENVISION DERMATOLOGY HOLDINGS INC
Entity type:Organization
Organization Name:ENVISION DERMATOLOGY HOLDINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIMHALL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:888-820-3376
Mailing Address - Street 1:116 DEFENSE HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7040
Mailing Address - Country:US
Mailing Address - Phone:888-820-3376
Mailing Address - Fax:888-826-4576
Practice Address - Street 1:116 DEFENSE HWY STE 102
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7040
Practice Address - Country:US
Practice Address - Phone:888-820-3376
Practice Address - Fax:888-826-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty