Healthcare Provider Details

I. General information

NPI: 1609894575
Provider Name (Legal Business Name): PARKER SKIN & AESTHETIC CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 PARK EAST DR SUITE #104
BEACHWOOD OH
44122-4338
US

IV. Provider business mailing address

3737 PARK EAST DR STE 109
BEACHWOOD OH
44122-4329
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-7333
  • Fax: 216-464-2696
Mailing address:
  • Phone: 216-464-7333
  • Fax: 216-342-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number35-058810
License Number StateOH

VIII. Authorized Official

Name: DR. LYDIA PARKER
Title or Position: PRESIDENT
Credential: MD
Phone: 216-464-7333