MEDICARE: COLUMBUS DERMATOLOGY CENTER, 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	34002937	OH

General Provider Information

NPI Number	:	1215117429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS DERMATOLOGY CENTER, INC.

Provider Business Mailing Address
First Line	:	2051 STRINGTOWN RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2930
Country	:	US
Telephone Number	:	614-539-1800
Fax Number	:	614-539-1815

Provider Business Practice Location Address
First Line	:	2051 STRINGTOWN RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2930
Country	:	US
Telephone Number	:	614-539-1800
Fax Number	:	614-539-1815

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT D VERONA
Credential	:	D.O.
Telephone Number	:	614-539-1800

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	06/02/2008

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