MEDICARE: UNITED DERMATOLOGY ASSOCIATES OF ARLINGTON, PLLC

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

General Provider Information

NPI Number	:	1386228930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED DERMATOLOGY ASSOCIATES OF ARLINGTON, PLLC

Provider Business Mailing Address
First Line	:	130 REGENCY PKWY
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-5167
Country	:	US
Telephone Number	:	817-261-1122
Fax Number	:	817-207-4189

Provider Business Practice Location Address
First Line	:	3132 MATLOCK RD STE 307
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2922
Country	:	US
Telephone Number	:	817-539-0959
Fax Number	:	817-207-4188

Authorized Official
Title or Position	:	OWNER
Name	:	JEANNINE K HOANG
Credential	:	MD
Telephone Number	:	817-261-1122

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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