Provider Demographics
NPI:1891319422
Name:DERMATOLOGY INSTITUTE AND SKIN CANCER CENTER LLC
Entity type:Organization
Organization Name:DERMATOLOGY INSTITUTE AND SKIN CANCER CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-834-7546
Mailing Address - Street 1:2783 BROWNWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2005
Mailing Address - Country:US
Mailing Address - Phone:352-834-7546
Mailing Address - Fax:
Practice Address - Street 1:2783 BROWNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163
Practice Address - Country:US
Practice Address - Phone:352-834-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty