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Contact Information

SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA
525 N DACIE PT
LECANTO, FL34461-8399
 Phone: 352-746-2200
 Fax: 352-746-9320
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Dermatopathology

207ND0900X 07 Physician/Dermatology
 

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
 

Procedural Dermatology

207NS0135X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA

NPI Number 1902890239
LBN Legal business name SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA
Authorized official RALPH MASSULLO - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 09/01/2005
Last updated 11/15/2011 - About 15 years ago
Identifiers
FL Medicaid 377238100
FL Other CA6816 SRRGA
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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