Charles V Perniciaro, M.D., P.C., D/B/a Brunswick Dermatology Clinic

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

Legal business name

CHARLES V PERNICIARO, M.D., P.C., D/B/A BRUNSWICK DERMATOLOGY CLINIC

Doing business as

Brunswick Dermatology Clinic

Practice address

183 Landrum LN
Suite 201
Ponte Vedra Beach, FL 32082-3837

Phone

(904) 241-0633

NPI assigned

Jul 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles Vincent Perniciaro, MDNPI 1972557890

Title

Owner

Phone

(904) 241-0633

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BRUNSWICK DERMATOLOGY CLINIC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Vincent Perniciaro, M.D.

  • Dermatopathology Physician
  • Tampa, FL
  • NPI 1972557890
  NPD (past) Authorized official

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417737600000",
    "number": "1497771869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51498",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322401498",
            "telephone_number": "904-241-0633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 LANDRUM LN",
            "address_2": "SUITE 201",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823837",
            "telephone_number": "904-241-0633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES V PERNICIARO, M.D., P.C., D/B/A BRUNSWICK DERMATOLOGY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2014-12-05",
        "status": "A",
        "authorized_official_last_name": "PERNICIARO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-241-0633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DA7309",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRUNSWICK DERMATOLOGY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Claire Castellano, LPC
• Clayton Christopher Celander, DMD
• Stephanie Michelle Ceparano
• Adam I. Chaifetz, D.C.
• Charles Perniciaro MD PA (Neptune Beach Dermatology)
• Christian Counseling Associates of Jacksonville
• Chae Hyung Chung
• Lauren Church
• Jessica Marie Clark, APRN
• Mary Kenley Clark, LICSW

• Dermatopathology Physician in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Dermatopathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; 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.