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General NPI Number Information
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NPI Number | 1508197112
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Entity Type | Organization
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Legal Business Name | OHIO SKIN CANCER INSTITUTE LLC
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 5040 FOREST DR STE 200
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City | NEW ALBANY
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State | OH
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Zip | 43054-8166
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Country | US
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Telephone | 614-585-9900
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Fax | 614-585-9999
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Provider Business Mailing Address
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Address Line | 5040 FOREST DR STE 200
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City | NEW ALBANY
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State | OH
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Zip | 43054-8166
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARISA RAVITSKIY
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Credential | MD
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Telephone | 614-585-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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