NPIMap

Organization Active NPI

Greenville Dermatology LLC

  • Dermatology Physician
  • Greenville, SC
National Provider Identifier
1740218189
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GREENVILLE DERMATOLOGY LLC
Practice address
369 Woodruff Rd
Greenville, SC 29607-3415
Phone
(864) 242-5872
Fax
(864) 242-5640
NPI assigned
Jun 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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

Authorized official

Name
Matthew L Miller, MD
Title
Owner
Phone
(864) 242-5640

Specialties & licenses 1

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

Addresses

Primary practice location

369 Woodruff Rd
Greenville, SC 29607-3415

Mailing address

PO Box 17527
Greenville, SC 29606-8527
Phone (864) 242-5872

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1740218189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17527",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296068527",
            "telephone_number": "864-242-5872",
            "fax_number": "864-242-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 WOODRUFF RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073415",
            "telephone_number": "864-242-5872",
            "fax_number": "864-242-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-242-5640",
        "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": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.