Basic Information
| Provider Information | |||||||||
| NPI: | 1033355060 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE DERMATOLOGY SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 BROWNS COVE RD STE 6 | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299368183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433792939 | ||||||||
| FaxNumber: | 8433792949 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 BROWNS COVE RD STE 6 | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299368183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433792939 | ||||||||
| FaxNumber: | 8433792949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2008 | ||||||||
| LastUpdateDate: | 12/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8433792939 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.