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General NPI Number Information
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NPI Number | 1992373062
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Entity Type | Organization
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Legal Business Name | CINCYSKIN MEDICAL AND COSMETIC DERMATOLOGY LLC
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 8300 KENWOOD RD STE A
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City | CINCINNATI
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State | OH
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Zip | 45236-2294
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Country | US
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Telephone | 513-393-9122
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Fax | 513-715-0003
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Provider Business Mailing Address
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Address Line | 8300 KENWOOD RD STE A
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City | CINCINNATI
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State | OH
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Zip | 45236-2294
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Country | US
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Telephone | 513-393-9122
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Fax | 513-715-0003
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELINE CHRISTINE FISHER
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Credential | DO
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Telephone | 937-681-0104
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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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