Organization
ORLANDO DERMATOLOGY CLINIC, LLC
Active
Other names
Care Dermatology and Skin Cancer Centers
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAREK SAMIR SHAATH MD (DERMATOLOGIST, LLC PRESIDENT)
(785) 760-6740
Entity
Organization
Contact information
Practice address
1040 LAKE SUMTER LNDG, THE VILLAGES, FL 32162-2697
(352) 218-3211
(877) 699-3709
Mailing address
697 OAK HOLLOW WAY, ALTAMONTE SPRINGS, FL 32714-1838
(785) 760-6740
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Enumeration date
04/02/2019
Last updated
05/21/2020
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