Organization
CHARLES V PERNICIARO, M.D., P.C., D/B/A BRUNSWICK DERMATOLOGY CLINIC
Active
Other names
BRUNSWICK DERMATOLOGY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES VINCENT PERNICIARO MD (OWNER)
(904) 241-0633
Entity
Organization
Contact information
Practice address
183 LANDRUM LN, SUITE 201, PONTE VEDRA BEACH, FL 32082-3837
(904) 241-0633
Mailing address
PO BOX 51498, JACKSONVILLE BEACH, FL 32240-1498
(904) 241-0633
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA7309
MEDICARE RAILROAD
GA
Enumeration date
07/15/2006
Last updated
12/05/2014
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