MEDICARE: DERMATOLOGY CENTER OF INDIANA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	01051020A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	070017306	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7430356	OTHER	IN	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033199138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY CENTER OF INDIANA PC

Provider Business Mailing Address
First Line	:	111 NEW HAMPSHIRE AVE STE 2
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-2864
Country	:	US
Telephone Number	:	802-909-2053
Fax Number	:	330-965-9325

Provider Business Practice Location Address
First Line	:	1100 SOUTHFIELD DR STE 1240
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-4499
Country	:	US
Telephone Number	:	317-838-9911
Fax Number	:	317-837-6080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT THOMAS GUENTHNER
Credential	:	M.D.
Telephone Number	:	317-838-9911

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	06/06/2023

Similar Medicare Providers

1336969328 — ANNIE PAIGE CLARK PA-C
Practice Location Address:

1100 SOUTHFIELD DR STE 1140
PLAINFIELD, IN
46168-4499

Practice Phone: 317-839-7200
Practice Fax:

1215917950 — KIMBERLY S BEREBITSKY M.D.
Practice Location Address:

1100 SOUTHFIELD DR STE 1240
PLAINFIELD, IN
46168-4499

Practice Phone: 317-838-9911
Practice Fax: 317-837-6080

1447205075 — MS. LOUISE L MCMILLAN LCSW
Practice Location Address:

1100 SOUTHFIELD DR , STE 1205
PLAINFIELD, IN
46168-4499

Practice Phone: 317-718-8436
Practice Fax: 317-718-8438

1104927557 — HENDRICKS COUNTY HOSPITAL
Practice Location Address:

1100 SOUTHFIELD DR STE 1210
PLAINFIELD, IN
46168-4499

Practice Phone: 317-839-4114
Practice Fax: 317-839-7749

1427141357 — DONALD JOHNSON MD
Practice Location Address:

1100 SOUTHFIELD DRIVE , SUITE 1210
PLAINFIELD, IN
46168-4499

Practice Phone: 317-839-9833
Practice Fax: 317-839-7549

1780896431 — JEREMY KEITH NIVENS NP
Practice Location Address:

1100 SOUTHFIELD DR STE 1240
PLAINFIELD, IN
46168-4499

Practice Phone: 317-838-9911
Practice Fax: 317-837-6080

Directions to “DERMATOLOGY CENTER OF INDIANA PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.