# DERMATOLOGIST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336899061
- **Authorized official:** DR. OLGA DEMIDOVA DO (DIRECTOR)
- **Authorized official phone:** (216) 280-1343

## Contact information

- **Practice address:** 9724 N ARMENIA AVE STE 300, TAMPA, FL 33612-7550
- **Practice address phone:** (440) 804-5996
- **Practice address fax:** (216) 758-4783
- **Mailing address:** 9724 N ARMENIA AVE STE 300, TAMPA, FL 33612-7550
- **Mailing address phone:** (440) 804-5996
- **Mailing address fax:** (216) 758-4783

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | NULL | Yes |
| 207ND0101X | MOHS-Micrographic Surgery Physician | — | — | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 03/25/2022
- **Last updated:** 06/04/2026