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General NPI Number Information
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NPI Number | 1386706125
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF OHIO, LLC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 8100 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-1702
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Country | US
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Telephone | 937-974-5247
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Fax |
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Provider Business Mailing Address
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Address Line | 6136 OLD SPANISH TRL
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City | DAYTON
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State | OH
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Zip | 45459-1453
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Country | US
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Telephone | 937-974-5247
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTHA HICKMANN
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Credential | MD
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Telephone | 937-974-5247
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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 | 35060161
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License Number State | OH
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