Healthcare Provider Details

I. General information

NPI: 1265297899
Provider Name (Legal Business Name): OHIODERM HOLDING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 PERIMETER DR STE 200
DUBLIN OH
43017-3224
US

IV. Provider business mailing address

5775 PERIMETER DR STE 200
DUBLIN OH
43017-3224
US

V. Phone/Fax

Practice location:
  • Phone: 614-845-0418
  • Fax: 614-389-3841
Mailing address:
  • Phone: 614-845-0418
  • Fax: 614-389-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL PATRICK CONROY
Title or Position: FOUNDER
Credential: MD
Phone: 614-943-0355