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Orlando Dermatology Clinic, LLC

NPI 1891257655ActiveOrganization· Dermatology, MOHS-Micrographic Surgery· The Villages, FL

Dermatology, MOHS-Micrographic Surgery in The Villages, Florida, registered in NPPES in April 2019. The authorized official on file is Tarek Samir Shaath, MD, Dermatologist, Llc President. Enrolled in Medicare as part b supplier - clinic/group practice.

Overview

NPI1891257655
StatusActive
Entity typeOrganization
NPI issuedApr 2, 2019
Last updated in NPPESMay 21, 2020
Certified by providerMay 21, 2020

Specialties and licenses

TaxonomyCodeLicenseState
Dermatology, MOHS-Micrographic Surgery Primary207ND0101X——
Dermatology207N00000X——
Dermatology, Dermatopathology207ND0900X——
Dermatology, Pediatric Dermatology207NP0225X——
Dermatology, Procedural Dermatology207NS0135X——
Non-Pharmacy Dispensing Site332900000X——

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 10, 2026No match—
New York OMIG · Nov 10, 2026No match—
Ohio Medicaid · Nov 10, 2026No match—
Pennsylvania Medicheck · Nov 10, 2026No match—
Washington HCA · Nov 10, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Enrolled Part B Supplier - Clinic/Group Practice (FL)

Medicare sources and data years

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