NPIMap

Organization Active NPI

Coastal Dermatology, LLC

  • Dermatology Physician
  • Mount Pleasant, SC
National Provider Identifier
1164690822
Registry record updated May 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
22838 Issued in SC
Legal business name
COASTAL DERMATOLOGY, LLC
Practice address
999 Lake Hunter Cir
Mount Pleasant, SC 29464-5427
Phone
(843) 881-2265
Fax
(843) 881-2789
NPI assigned
Feb 15, 2008
Last updated
May 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michele Ann Mittlebronn, M.D.
Title
Billing/ Credentialing
Phone
(843) 881-2265

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 22838 SC Primary

Addresses

Primary practice location

999 Lake Hunter Cir
Mount Pleasant, SC 29464-5427

Mailing address

999 Lake Hunter Cir
Mount Pleasant, SC 29464-5427
Phone (843) 881-2265

National Provider Directory

National Provider Directory

Locations

245 Seven Farms Dr
Ste 210
Daniel Island, SC 29492
Phone (843) 881-2130

2705 N Highway 17
#200
Mount Pleasant, SC 29466
Phone (843) 876-0444

2705 Highway 17 Byp N
#200
Mt Pleasant, SC 29466

999 Lake Hunter Cir
Ste B
Mt Pleasant, SC 29464
Phone (843) 388-3120

8667 Ocean Hwy
Pawleys Island, SC 29585
Phone (843) 235-9060

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304985600000",
    "number": "1164690822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 LAKE HUNTER CIR",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294645427",
            "telephone_number": "843-881-2265",
            "fax_number": "843-881-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 LAKE HUNTER CIR",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294645427",
            "telephone_number": "843-881-2265",
            "fax_number": "843-881-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2011-05-10",
        "status": "A",
        "authorized_official_last_name": "MITTLEBRONN",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BILLING/ CREDENTIALING",
        "authorized_official_telephone_number": "843-881-2265",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SC",
            "license": "22838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.