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WATER'S EDGE DERMATOLOGY LLC NPI 1134148992


NPI Information

NPI: 1134148992
Provider Name: WATER'S EDGE DERMATOLOGY, LLC

Former Legal Business Name: WATER'S EDGE DERMATOLOGY, INC

Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 10D1038179

Address:
600 VILLAGE SQUARE CROSSING
PALM BEACH GARDENS, FL
ZIP 33410
Phone: (561) 694-9493
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WATER'S EDGE DERMATOLOGY, LLC is a dermatology in Palm Beach Gardens, FL. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. WATER'S EDGE DERMATOLOGY, LLC NPI is 1134148992. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Water's Edge Dermatology, Inc.

The provider's business location address is:

600 VILLAGE SQUARE CROSSING
PALM BEACH GARDENS, FL
ZIP 33410
Phone: (561) 694-9493
Fax: (561) 694-9064

The provider's authorized official is Susan Davis .
The authorized official title is Dir. Billing Ops and has the following contact phone number (561) 693-0540.

The CLIA number assigned to this NPI record is 10D1038179 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 7/19/2006 and was last updated on 12/11/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
138243OTHERFLORIDABCBS
2K1053AMEDICARE PINFLORIDA
3K1053BMEDICARE PINFLORIDA
4K1053CMEDICARE PINFLORIDA
5K1053MEDICARE PINFLORIDA
6K1053DMEDICARE PINFLORIDA
7K1053EMEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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