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General NPI Number Information
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NPI Number | 1386557601
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY DIRECT LLC
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Dates
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Enumeration Date | 09/26/2026
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Last Update Date | 09/26/2026
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Provider Practice Location Address
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Address Line | 20 N GRAND AVE STE 8
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City | FORT THOMAS
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State | KY
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Zip | 41075-1755
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Country | US
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Telephone | 859-712-3007
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Fax | 859-712-3007
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Provider Business Mailing Address
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Address Line | 20 N GRAND AVE STE 8
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City | FORT THOMAS
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State | KY
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Zip | 41075-1755
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Country | US
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Telephone | 859-712-3007
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Fax | 859-712-3007
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Authorized Official
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Title or Position | OWNER/DERMATOLOGIST
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Name | DR. JENNIFER MARTIN
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Credential | MD, FAAD
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Telephone | 615-500-3151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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