Derm MD LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERM MD LLC

Practice address

2964 N State Road 7 Ste 200
Margate, FL 33063-5715

Phone

(954) 648-1616

Fax

(817) 612-3586

NPI assigned

Dec 7, 2021

Organization subpart

No

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

Authorized official

Name

Nashay N Clemetson, MD

Title

Owner

Phone

(954) 648-1616

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1952069965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2964 N STATE ROAD 7 STE 200",
            "city": "MARGATE",
            "state": "FL",
            "postal_code": "330635715",
            "fax_number": "817-612-3586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2964 N STATE ROAD 7 STE 200",
            "city": "MARGATE",
            "state": "FL",
            "postal_code": "330635715",
            "telephone_number": "954-648-1616",
            "fax_number": "817-612-3586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERM MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-03",
        "status": "A",
        "authorized_official_last_name": "CLEMETSON",
        "authorized_official_first_name": "NASHAY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-648-1616",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@3sixtyderm.com",
            "affiliation": "N",
            "address_1": "2964 N State Road 7 Ste 200",
            "city": "Margate",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330635715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; 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.