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Organization
VISAGE DERMATOLOGY, LLC
Active
Organization
VISAGE DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRIA KONGSIRI M.D. (PHYSICIAN)
(727) 388-6982
Entity
Organization
Contact information
Practice address
5253 CENTRAL AVE, ST PETERSBURG, FL 33710-8141
(727) 388-6982
Mailing address
5253 CENTRAL AVE, ST PETERSBURG, FL 33710-8141
(727) 388-6982
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME83035
FL
Other
Enumeration date
09/25/2006
Last updated
07/17/2008
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