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DERMATOLOGIST LLC
NPI 1336899061
Dermatology - MOHS-Micrographic Surgery in Tampa, FL

Active since March 25, 2022
9724 N ARMENIA AVE STE 300, TAMPA, FL 33612(440) 804-5996(216) 758-4783 Get Directions Write a Review

NPPES record last updated: June 4, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 4, 2026, Aug 4, 2025 (2 updates tracked since 2025).

About Dermatologist Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGIST LLC (NPI 1336899061) is a healthcare organization registered as a mohs-micrographic surgery in Tampa, Florida and active in the NPI registry since March 2022. The organization lists Olga Demidova, Director, as its authorized official.

NPPES Registry Identity

NPI1336899061
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameDERMATOLOGIST LLC
Location Address9724 N ARMENIA AVE STE 300Tampa, FL 33612-7550
Mailing Address9724 N Armenia Ave Ste 300Tampa, FL 33612-7550 · (440) 804-5996 · Fax (216) 758-4783
Phone(440) 804-5996
Fax(216) 758-4783
Organization SubpartNo
Authorized OfficialOlga DemidovaDirector · (216) 280-1343
Enumeration DateMarch 25, 2022
Last NPPES UpdateJune 4, 20262 updates tracked since enumeration
NPPES CertifiedJune 4, 2026
✔ NPI 1336899061 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
Also ListedDermatologyTaxonomy 207N00000X
9724 N ARMENIA AVE STE 300, Tampa, FL 33612
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dermatologist Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Dermatologist LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Olga Demidova, DO
Dermatology
NPI 1174915987
9724 N ARMENIA AVE STE 300
Tampa, FL 33612
(216) 804-5996
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatologist LLC's NPI number?

The NPI number for Dermatologist LLC is 1336899061. It was assigned to this organization in the NPPES registry on March 25, 2022.

Where is Dermatologist LLC located?

Dermatologist LLC is located at 9724 N Armenia Ave Ste 300, Tampa, FL 33612. The listed phone number is (440) 804-5996.

What is Dermatologist LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Dermatologist LLC enrolled in Medicare?

Yes. Dermatologist LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dermatologist LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Dermatologist LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Dermatologist LLC was last updated on June 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.