Provider Demographics
NPI:1164122347
Name:SUNSHINE STATE DERMATOLOGY AND SKIN CANCER CENTER INC
Entity type:Organization
Organization Name:SUNSHINE STATE DERMATOLOGY AND SKIN CANCER CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-282-3376
Mailing Address - Street 1:88 SUGAR MILL DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9077
Mailing Address - Country:US
Mailing Address - Phone:941-228-9183
Mailing Address - Fax:
Practice Address - Street 1:12497 TAMIAMI TRL S, UNIT 1
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1415
Practice Address - Country:US
Practice Address - Phone:941-282-3376
Practice Address - Fax:941-282-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLYCEA9OtherBCBS PAYER ID
1932193729OtherNPI