MEDICARE: ADVANCED DERMATOLOGY OF ALASKA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207NP0225X	Pediatric Dermatology Physician
2	207ND0101X	MOHS-Micrographic Surgery Physician
3	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1760356208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DERMATOLOGY OF ALASKA

Provider Business Mailing Address
First Line	:	1100 E DIMOND BLVD STE 103
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-2001
Country	:	US
Telephone Number	:	907-232-0251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E DIMOND BLVD STE 103
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-2001
Country	:	US
Telephone Number	:	907-267-5890
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MONA LEDDY
Credential	:
Telephone Number	:	907-267-5890

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	12/12/2025

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Directions to “ADVANCED DERMATOLOGY OF ALASKA ” Practice Location

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