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General NPI Number Information
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NPI Number | 1770971350
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Entity Type | Organization
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Legal Business Name | CITY DERMATOLOGY AND LASER
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 1 W 4TH ST SUITE 2200
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City | CINCINNATI
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State | OH
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Zip | 45202-3604
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Country | US
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Telephone | 513-421-3376
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Fax | 513-618-2128
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Provider Business Mailing Address
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Address Line | 1 W 4TH ST SUITE 2200
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City | CINCINNATI
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State | OH
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Zip | 45202-3604
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Country | US
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Telephone | 513-421-3376
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Fax | 513-618-2128
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Authorized Official
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Title or Position | OWNER
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Name | LANA LONG
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Credential | MD
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Telephone | 513-421-3376
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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 | 35.068727
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License Number State | OH
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