Delmarva Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DELMARVA DERMATOLOGY, LLC

Practice address

32895 Coastal Hwy # 102a
Bethany Beach, DE 19930-3782

Phone

(302) 402-3015

Fax

(302) 402-5942

NPI assigned

Mar 24, 2019

Last updated

Mar 24, 2019By 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

Jennifer Z. Cooper, M.D.NPI 1619918356

Title

Owner

Phone

(302) 402-3015

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

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.

• Jennifer Zahn Cooper, M.D.

  • MOHS-Micrographic Surgery Physician
  • Abingdon, MD
  • NPI 1619918356

  DE, Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Jillian Laura Mudry

  • Nurse Practitioner
  • Ocean View, DE
  • NPI 1932653854
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1553385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553385600000",
    "number": "1568922672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1329",
            "city": "BETHANY BEACH",
            "state": "DE",
            "postal_code": "199301329",
            "telephone_number": "302-402-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32895 COASTAL HWY # 102A",
            "city": "BETHANY BEACH",
            "state": "DE",
            "postal_code": "199303782",
            "telephone_number": "302-402-3015",
            "fax_number": "302-402-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELMARVA DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-24",
        "last_updated": "2019-03-24",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "Z.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-402-3015",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Beach Volunteer Fire Co. Inc
• Bethany Dental Associates
• Bethany Primary Care
• Elinor Brown, DMD
• Delaware CVS Pharmacy LLC (CVS Pharmacy# 04710)
• David Fantozzi, RPH
• Marianne Fike, M.AC., LMT
• Blair Heckel
• Mark Jorge Heintz, MSCAADC
• Rosemay Anne Herrmann, FNP

• Dermatology Physician in Bethany Beach, DE
• Providers in Bethany Beach, DE by specialty
• Dermatology Physician in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2019; 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.