Healthcare Provider Details

I. General information

NPI: 1407962210
Provider Name (Legal Business Name): DERMATOLOGY CENTERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 DAVIS STUART ROAD
RONCEVERTE WV
24970
US

IV. Provider business mailing address

103 DAVIS STUART ROAD
RONCEVERTE WV
24970
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-7546
  • Fax: 304-645-7547
Mailing address:
  • Phone: 304-645-7546
  • Fax: 304-645-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number14295
License Number StateWV

VIII. Authorized Official

Name: THOMAS M KARRS
Title or Position: PRESIDENT
Credential: MD
Phone: 304-645-7546