Healthcare Provider Details

I. General information

NPI: 1962402776
Provider Name (Legal Business Name): TRI COUNTY DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 GRAHAM RD SUITE C
CUYAHOGA FALLS OH
44221-1344
US

IV. Provider business mailing address

4240 MUNSON ST NW STE C
CANTON OH
44718-2978
US

V. Phone/Fax

Practice location:
  • Phone: 330-929-9009
  • Fax: 330-929-6264
Mailing address:
  • Phone: 330-492-2327
  • Fax: 330-492-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34003166
License Number StateOH

VIII. Authorized Official

Name: DR. SCHIELD MARTIN WIKAS
Title or Position: OWNER/GENERAL PARTNER
Credential: DO
Phone: 330-929-9009