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General NPI Number Information
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NPI Number | 1669661138
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF MANSFIELD, INC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 480 GLESSNER AVE
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City | MANSFIELD
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State | OH
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Zip | 44903-2056
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Country | US
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Telephone | 419-526-2600
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Fax | 419-526-2032
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Provider Business Mailing Address
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Address Line | 480 GLESSNER AVENUE
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City | MANSFIELD
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State | OH
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Zip | 44903
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Country | US
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Telephone | 419-526-2600
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Fax | 419-526-2032
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY C. WOOD
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Credential | M.D.
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Telephone | 419-526-2600
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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 | 42777
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35074869W
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License Number State | OH
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