Westside Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

16384 Issued in SC

Legal business name

WESTSIDE DERMATOLOGY, LLC

Practice address

1410B John B White Sr Blvd
Spartanburg, SC 29306-3927

Phone

(864) 574-0017

Fax

(864) 574-6088

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Peter J Neidenbach, M.D.

Title

Member

Phone

(864) 574-0017

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1801013719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410B JOHN B WHITE SR BLVD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293063927",
            "telephone_number": "864-574-0017",
            "fax_number": "864-574-6088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410B JOHN B WHITE SR BLVD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293063927",
            "telephone_number": "864-574-0017",
            "fax_number": "864-574-6088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "NEIDENBACH",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "864-574-0017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "16384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Westgate Training and Consultation Network
• Weston Rehabilitation South Carolina LLC (Skylyn Place)
• Laurel Andrea Weston, M.D.
• Wendy Stanton Weston, CRNA
• Westside Chiropractic & Sports Medicine, LLC
• Westside Eye Center LLC
• Westside Internal Medicine, LLC
• Westside Optical Shop,LLC
• Jayna Meyer Wettlin, MSP, CCC-SLP
• Ashley Harris Whaley

• Dermatology Physician in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.