Basic Information
| Provider Information | |||||||||
| NPI: | 1710373352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ON SITE DERMATOLOGY OF SOUTH CAROLINA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 CLINT MOORE RD | ||||||||
| Address2: | SUITE 227 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613142000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 902 CLINT MOORE RD | ||||||||
| Address2: | SUITE 227 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613142000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2015 | ||||||||
| LastUpdateDate: | 04/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | PLOTKIN | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 5613142000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.