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General NPI Number Information
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NPI Number | 1912220799
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Entity Type | Organization
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Legal Business Name | ENCORE DERMATOLOGY, INC
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 4900 GETTYSBURG RD
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City | COLUMBUS
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State | OH
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Zip | 43220-2520
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Country | US
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Telephone | 614-442-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 GETTYSBURG RD
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City | COLUMBUS
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State | OH
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Zip | 43220-2520
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Country | US
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Telephone | 614-442-1012
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Fax | 614-442-7726
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Authorized Official
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Title or Position | OWNER
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Name | DR. GWYN R LONDEREE
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Credential | M.D.
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Telephone | 614-442-1012
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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 |
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License Number State |
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