Provider Demographics
NPI:1679857452
Name:ACADEMIC ALLIANCE IN DERMATOLOGY
Entity type:Organization
Organization Name:ACADEMIC ALLIANCE IN DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-884-3091
Mailing Address - Street 1:4238 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2231
Mailing Address - Country:US
Mailing Address - Phone:813-879-6060
Mailing Address - Fax:813-879-3049
Practice Address - Street 1:4238 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2231
Practice Address - Country:US
Practice Address - Phone:813-879-6040
Practice Address - Fax:813-897-6049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site