Organization Name: | TIDEWAY DERMATOLOGY |
NPI Number: | 1619054525 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID FRANKLIN JAFFE (OWNER) |
Mailing Address: | 323 S Union Ave Havre De Grace |
State: | MD US |
Postal Code: | 210783201 |
Phone Number: | 4109390961 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 04/20/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | D0045614 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |