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Organization
DERMATOLOGIST LLC
Active
Organization
DERMATOLOGIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLGA DEMIDOVA DO (DIRECTOR)
(216) 280-1343
Entity
Organization
Contact information
Practice address
9724 N ARMENIA AVE STE 300, TAMPA, FL 33612-7550
(440) 804-5996
(216) 758-4783
Mailing address
9724 N ARMENIA AVE STE 300, TAMPA, FL 33612-7550
(440) 804-5996
(216) 758-4783
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
NULL
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
03/25/2022
Last updated
06/04/2026
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