Provider Demographics
NPI:1437347556
Name:BAY AREA SKIN CANCER SURGERY AND DERMATOLOGY LLC
Entity type:Organization
Organization Name:BAY AREA SKIN CANCER SURGERY AND DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-748-4747
Mailing Address - Street 1:702 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8663
Mailing Address - Country:US
Mailing Address - Phone:941-748-4747
Mailing Address - Fax:
Practice Address - Street 1:702 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8663
Practice Address - Country:US
Practice Address - Phone:941-748-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7477Medicare PIN