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Contact Information

ORLANDO DERMATOLOGY CLINIC, LLC
1040 LAKE SUMTER LNDG
THE VILLAGES, FL32162-2697
 Phone: 352-218-3211
 Fax: 877-699-3709
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
 

Dermatology

207N00000X 07 Physician/Dermatology
 

Dermatopathology

207ND0900X 07 Physician/Dermatology
 

Non-Pharmacy Dispensing Site

332900000X 87 All Other Suppliers
 

Pediatric Dermatology

207NP0225X 07 Physician/Dermatology
 

Procedural Dermatology

207NS0135X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for ORLANDO DERMATOLOGY CLINIC, LLC

NPI # 1891257655
LBN Legal business name ORLANDO DERMATOLOGY CLINIC, LLC
Authorized official TAREK SHAATH - (DERMATOLOGIST, LLC PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 04/02/2019
Last updated 05/21/2020 - About 6 years ago
Identifiers n/a
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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