MEDICARE: AKRON DERMATOLOGY ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	35085787	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	LI4159351	OTHER	OH	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134451446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKRON DERMATOLOGY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	3085 W MARKET ST STE 102
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3620
Country	:	US
Telephone Number	:	330-836-0201
Fax Number	:	330-836-9406

Provider Business Practice Location Address
First Line	:	3085 W MARKET ST STE 102
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3620
Country	:	US
Telephone Number	:	330-836-0201
Fax Number	:	330-836-9406

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES F LIBECCO
Credential	:	M.D.
Telephone Number	:	330-836-0201

Provider Enumeration Date	:	02/11/2010
Last Update Date	:	02/11/2010

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Directions to “AKRON DERMATOLOGY ASSOCIATES INC ” Practice Location

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