901 Skinmd PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 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

Last updated

May 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Radoslaw Bieniek, MDNPI 1083853006

Title

Physician

Phone

(781) 467-8632

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 2

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.

• Radoslaw Filip Bieniek, M.D.

  • Dermatopathology (Pathology) Physician
  • Greensboro, NC
  • NPI 1083853006

  TN

  Medicare reassignment Authorized official
• Cesar Enrique Guerrero, MD

  • Dermatology Physician
  • Grenada, MS
  • NPI 1720378169

  Single Specialty

  NPD

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

{
    "created_epoch": "1542931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1346719085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10020 IBERVILLE CV",
            "city": "LAKELAND",
            "state": "TN",
            "postal_code": "380027804",
            "telephone_number": "781-467-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 WALNUT KNOLL LANE",
            "address_2": "SUITE 2",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380186301",
            "telephone_number": "781-467-8632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "901 SKINMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-23",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "BIENIEK",
        "authorized_official_first_name": "RADOSLAW",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "781-467-8632",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• A Guardian Care Group
• A Plus Health Supplies
• Noida Anna Ababao-Alexander, PT

• Dermatology Physician in Cordova, TN
• Providers in Cordova, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.