DR. MICHAEL ROBERT CENTILLI (NPI# 1215223326) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215223326 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL ROBERT CENTILLI |
| Credential | D.O. |
| Practice Address |
5046 Highway 17 Byp S Ste 103 Myrtle Beach SC 29588-4503 |
| Practice Telephone | 8436684104 |
| Practice Fax Number | 8436684108 |
| Mailing Telephone | 8436684104 |
| Mailing Fax Number | 8436684108 |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2018-09-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 52108 | SC | Allopathic & Osteopathic Physicians |
| Street Address |
5046 HIGHWAY 17 BYP S STE 103 |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29588-4503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750553152 | Daniella Deperi | Physician Assistant | 5046 Highway 17 Byp S Ste 103, Myrtle Beach, SC 29588-4503 | 2008-03-26 |
| 1942700091 | Ashley G Parker | Nurse Practitioner | 5046 Highway 17 Byp S Ste 103, Myrtle Beach, SC 29588-4503 | 2018-02-15 |
| 1558735878 | Matthew Janowicz | Physician Assistant | 5046 Highway 17 Byp S Ste 103, Myrtle Beach, SC 29588-4503 | 2015-11-24 |
| 1093068538 | Elizabeth M Duffy | Physician Assistant | 5046 Highway 17 Byp S Ste 103, Myrtle Beach, SC 29588 | 2012-10-22 |
| 1538460506 | Christopher Francis Buthorn | Physician Assistant | 5046 Highway 17 Byp S Ste 103, Myrtle Beach, SC 29588 | 2010-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740819309 | Forrest Halsey Westley | Pharmacist | 3072 Dick Pond Rd. Suite 2, Myrtle Beach, SC 29588 | 2020-04-06 |
| 1588124176 | The Counseling Center of Sayebrook | Counselor | 106 Lansford Court Suite 202, Myrtle Beach, SC 29588 | 2019-03-21 |
| 1134631443 | Solid Foundations, LLC | Clinic/Center | 4325 Dick Pond Road, Suite E, Myrtle Beach, SC 29588 | 2017-10-26 |
| 1316496037 | Grand Strand Rehab and Nursing Center, LLC | Skilled Nursing Facility | 4452 Socastee Boulevard, Myrtle Beach, SC 29588 | 2016-09-22 |
| 1386092039 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 1370 South Commons Drive, Suite 102, Myrtle Beach, SC 29588 | 2016-06-02 |
| 1114314531 | Allison Smith | Physical Therapy Assistant | 4870 Socastee Blvd, Myrtle Beach, SC 29588 | 2015-04-23 |
| 1760806160 | Myrtle Beach Physical Medicine & Rehab, LLC | Family Medicine | 4736 17 Bypass South, Myrtle Beach, SC 29588 | 2014-02-06 |
| 1801228499 | Robin Ruth Gause | Lactation Consultant, Non-RN | 510 Fairwood Lakes Ave, 14-c, Myrtle Beach, SC 29588 | 2013-08-06 |
| 1124386438 | Horace Earl Ferguson Jr. | Technician/Technologist | 4535 Dick Pond Road, A, Myrtle Beach, SC 29588 | 2012-04-25 |
| 1831463652 | Medeyecare, LLC | Technician/Technologist | 4335 Socastee Blvd, Unit A, Myrtle Beach, SC 29588 | 2012-02-24 |
| Find all providers in zip 29588 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982641106 | Carl Edward Weimer Jr. | Dermatology | 1240 21st Avenue N, Suite 106, Myrtle Beach, SC 29577-7431 | 2006-05-31 |
| 1962449181 | Waccamaw Dermatology, LLC | Dermatology | 917 Medical Circle, Myrtle Beach, SC 29572 | 2006-05-31 |
| 1033160213 | Grand Strand Dermatology | Dermatology | 3001 Newcastle Loop, Myrtle Beach, SC 29588-4502 | 2006-05-13 |
| 1306819990 | Daniel B Ward Jr. | Dermatology | 8208 Devon Ct, Suite B, Myrtle Beach, SC 29572-4178 | 2006-02-13 |
| 1497759278 | Luther Rawls Williams Jr. | Dermatology | 4573 Oleander Dr, Myrtle Beach, SC 29577-5755 | 2005-06-09 |
| 1245627439 | Michael Xiong | Dermatology | 917 Medical Cir, Myrtle Beach, SC 29572-4116 | 2015-04-25 |
| 1073946315 | Dermatology and Skin Cancer Center of South Carolina PC | Dermatology | 5046 Highway 17 Byp S, Suite 103, Myrtle Beach, SC 29588-4503 | 2013-08-09 |
| 1720309941 | Mary Hollingsworth Bowdre Glover | Dermatology | 3001 Newcastle Loop, Myrtle Beach, SC 29588-4502 | 2010-06-22 |
| 1306072566 | Weimer Skin Clinic, P.a. | Dermatology | 1240 21st Avenue N, Suite 106, Myrtle Beach, SC 29577-7431 | 2009-06-02 |
| 1437308814 | Waccamaw Dermatology and Plastic Surgery | Dermatology | 917 Medical Circle, Myrtle Beach, SC 29572-4116 | 2008-09-10 |
| Find all providers in MYRTLE BEACH | ||||
| City | MYRTLE BEACH |
| Zip Code | 29588 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.