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General NPI Number Information
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NPI Number | 1063565513
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CENTRE OF NORTHEAST OHIO, LLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 960 WINDHAM CT SUITE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512
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Country | US
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Telephone | 330-758-8866
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Fax | 330-758-4051
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Provider Business Mailing Address
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Address Line | 960 WINDHAM CT SUITE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512
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Country | US
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Telephone | 330-758-8866
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Fax | 330-758-4051
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. TERRI L STILSON
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Credential |
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Telephone | 330-758-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35059099
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License Number State | OH
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