Healthcare Provider Details

I. General information

NPI: 1730277583
Provider Name (Legal Business Name): FORT WAYNE DERMATOLOGY CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7881 CARNEGIE BLVD
FORT WAYNE IN
46804-5792
US

IV. Provider business mailing address

7881 CARNEGIE BLVD
FORT WAYNE IN
46804-5792
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-8000
  • Fax: 260-432-5587
Mailing address:
  • Phone: 260-436-8000
  • Fax: 260-432-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD C SARKISIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 260-436-8000