=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467526731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DERMATOLOGY SPECIALISTS OF GREATER CINCINNATI INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 02/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7794 5 MILE RD SUITE 240
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45230-2368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-231-1575
-----------------------------------------------------
Fax | 855-818-3918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7794 5 MILE RD SUITE 240
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45230-2368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-231-1575
-----------------------------------------------------
Fax | 513-232-8490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JESSICA GROSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-482-8968
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------