| Justin Ross Wasserman Md Pl | |
|
1111 Avenida Del Circo Venice FL 34285-4108 | |
| (941) 484-8222 | |
| (941) 486-3016 |
| Full Name | Justin Ross Wasserman Md Pl |
|---|---|
| Speciality | Clinic/Center |
| Location | 1111 Avenida Del Circo, Venice, Florida |
| Authorized Official Name and Position | Justin Ross Wasserman (PRESIDENT) |
| Authorized Official Contact | 9414848222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Justin Ross Wasserman Md Pl 1111 Avenida Del Circo Venice FL 34285-4108 Ph: (941) 484-8222 | Justin Ross Wasserman Md Pl 1111 Avenida Del Circo Venice FL 34285-4108 Ph: (941) 484-8222 |
| NPI Number | 1891098612 |
|---|---|
| Provider Enumeration Date | 12/16/2010 |
| Last Update Date | 12/16/2010 |
| Medicare PECOS PAC ID | 3779772579 |
|---|---|
| Medicare Enrollment ID | O20110110000699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891098612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME106806 (Florida) | Primary |
| Provider Name | Justin R Wasserman |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1043453970 PECOS PAC ID: 6800940727 Enrollment ID: I20110202000579 |
| Provider Name | Penelope Kallis Skopis |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1952806531 PECOS PAC ID: 1951733120 Enrollment ID: I20230806000000 |
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