NPIMap

Organization Active NPI

Beachside Dermatology, LLC

  • Dermatology Physician
  • Melbourne, FL
National Provider Identifier
1851532683
Registry record updated Jun 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BEACHSIDE DERMATOLOGY, LLC
Practice address
2571 W Eau Gallie Blvd
Suite 2
Melbourne, FL 32935-8954
Phone
(321) 777-9091
NPI assigned
Mar 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2009

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

Authorized official

Name
Dr. Rosalind A Freas, MDNPI 1275594277
Title
Physician
Phone
(321) 773-1266

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

2571 W Eau Gallie Blvd
Suite 2
Melbourne, FL 32935-8954

Mailing address

2571 W Eau Gallie Blvd
Suite 2
Melbourne, FL 32935-8954
Phone (321) 777-9091

National Provider Directory

National Provider Directory

Locations

2571 W Eau Gallie Blvd
Ste 2
Melbourne, FL 32935
Phone (321) 777-9091

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1851532683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2571 W EAU GALLIE BLVD",
            "address_2": "SUITE 2",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358954",
            "telephone_number": "321-777-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2571 W EAU GALLIE BLVD",
            "address_2": "SUITE 2",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358954",
            "telephone_number": "321-777-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHSIDE DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "FREAS",
        "authorized_official_first_name": "ROSALIND",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "321-773-1266",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.