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General NPI Number Information
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NPI Number | 1912464157
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Entity Type | Organization
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Legal Business Name | LUCENT DERMATOLOGY AND SKIN SURGERY CENTER CORP
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 2000 AUBURN DR STE 120
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City | BEACHWOOD
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State | OH
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Zip | 44122-4328
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Country | US
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Telephone | 440-234-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 7550 LUCERNE DR STE 405
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City | MIDDLEBURG HEIGHTS
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State | OH
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Zip | 44130-6503
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Country | US
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Telephone | 440-234-8833
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | WILLIAM CAMP
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Credential | MD
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Telephone | 205-612-6412
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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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