901 Skinmd PLLC
Organization Active NPI Dermatology Physician · Cordova, TN
NPI 1346719085 · NPPES record last updated May 18, 2023
Key facts
- NPI
- 1346719085
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- 901 SKINMD PLLC
- Practice address
- 751 Walnut Knoll Lane
Suite 2
Cordova, TN 38018-6301 - Phone
- (781) 467-8632
- NPI assigned
- Nov 23, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Radoslaw Bieniek, MD
- Title
- Physician
- Phone
- (781) 467-8632
Practitioners 2
-
Radoslaw Filip Bieniek, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190423002613 | TN | Part B Supplier - Clinic/Group Practice | 9830431873 |
Receives reassigned benefits from 1 practitioner Practice locations: Cordova, TN |
National Provider Directory
Locations
751 Walnut Knoll Ln
Ste 2
Cordova, TN 38018
Phone (781) 467-8632
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
751 Walnut Knoll Lane
Suite 2
Cordova, TN 38018-6301
Mailing address
10020 Iberville CV
Lakeland, TN 38002-7804
Phone (781) 467-8632
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083853006 | Other | NPPES |
Other providers in Cordova, TN
- 1 And Only Home Health Services
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- A Fresh Start to a New Beginning
- A Guardian Care Group
- A Plus Health Supplies
- Noida Anna Ababao-Alexander
All providers in Cordova, TN · Dermatology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.