Healthcare Provider Details

I. General information

NPI: 1902285943
Provider Name (Legal Business Name): OHIO MEDICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NILES CORTLAND RD NE WEXFORD CENTER UNIT 10
WARREN OH
44484-1077
US

IV. Provider business mailing address

22901 HALBURTON RD
BEACHWOOD OH
44122-3962
US

V. Phone/Fax

Practice location:
  • Phone: 508-410-2586
  • Fax:
Mailing address:
  • Phone: 508-410-2586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.099878
License Number StateOH

VIII. Authorized Official

Name: DR. MORGAN HOTT
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 508-410-2586