Suncoast Dermatology and Skin Surgery Center, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA

Practice address

525 N Dacie PT
Lecanto, FL 34461-8399

Phone

(352) 746-2200

Fax

(352) 746-9320

NPI assigned

Sep 1, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Ralph Eugene Massullo Jr., MD

Title

President

Phone

(352) 746-2200

Specialties & licenses 4

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1902890239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N DACIE PT",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344618399",
            "telephone_number": "352-746-2200",
            "fax_number": "352-746-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N DACIE PT",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344618399",
            "telephone_number": "352-746-2200",
            "fax_number": "352-746-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST DERMATOLOGY AND SKIN SURGERY CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "MASSULLO",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-746-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "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": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SRRGA",
            "identifier": "CA6816",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377238100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keely M Staten, PA-C
• David Thomas John Stimson, PHARMD
• David Strang
• Sun MD PLLC
• Suncoast Anesthesia LLC
• Surrey Place of Lacanto LLC
• Tampa Vamc
• Gopal Tatambhotla, MD
• Carmenetta Alicia Terrell, BS
• The Achievement Center of Citrus County, P.a.

• Dermatology Physician in Lecanto, FL
• Providers in Lecanto, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; 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.