NPIMap

Organization Active NPI

National Dermatology Healthcare of Connecticut, LLC

  • Dermatology Physician
  • Tampa, FL
National Provider Identifier
1184969891
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NATIONAL DERMATOLOGY HEALTHCARE OF CONNECTICUT, LLC
Practice address
8002 Gunn Hwy
Tampa, FL 33626-1603
Phone
(813) 880-7546
NPI assigned
Dec 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Authorized official

Name
Josh Maywalt
Title
Billing Supervisor
Phone
(813) 880-7546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

8002 Gunn Hwy
Tampa, FL 33626-1603

Mailing address

8002 Gunn Hwy
Tampa, FL 33626-1603

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1184969891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8002 GUNN HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336261603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8002 GUNN HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336261603",
            "telephone_number": "813-880-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL DERMATOLOGY HEALTHCARE OF CONNECTICUT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "MAYWALT",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "813-880-7546"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.