Legacy Dermatology PLLC
NPI 1053024554ActiveOrganization· Dermatology· Algonquin, IL
Dermatology in Algonquin, Illinois, registered in NPPES in December 2022. The authorized official on file is Laurence Bradley, MD, Md/Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1053024554 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 29, 2022 |
| Last updated in NPPES | May 22, 2023 |
| Certified by provider | May 22, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | — | — |
| Dermatology, Procedural Dermatology | 207NS0135X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
Other Dermatology providers in Algonquin
- 1144610080
- 1093219610
- 1639516313
- 1598824732