Healthcare Provider Details

I. General information

NPI: 1831231745
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FOUNTAIN CT
LEXINGTON KY
40509-1888
US

IV. Provider business mailing address

250 FOUNTAIN CT
LEXINGTON KY
40509-1888
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-4444
  • Fax: 859-543-8867
Mailing address:
  • Phone: 859-263-4444
  • Fax: 859-543-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number200197
License Number StateKY

VIII. Authorized Official

Name: DR. FERNANDO DE CASTRO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 859-263-4444