Healthcare Provider Details

I. General information

NPI: 1033203815
Provider Name (Legal Business Name): DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date: 08/19/2022
Reactivation Date: 10/05/2022

III. Provider practice location address

725 LAKEFRONT CT
CARMEL IN
46032-5893
US

IV. Provider business mailing address

875 AIRPORT PKWY
GREENWOOD IN
46143-1085
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-3739
  • Fax: 317-921-7478
Mailing address:
  • Phone: 317-926-3739
  • Fax: 317-921-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANA MARIA BORA
Title or Position: BILLING MANAGER
Credential:
Phone: 317-926-3739