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NPI Code Detail

MEDICARE: UNIVERSITY HOSPITAL DERMATOLOGY ASSOCIATES INC

MEDICARE: UNIVERSITY HOSPITAL DERMATOLOGY ASSOCIATES INC
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
1207ND0900XDermatopathology Physician
2207ND0101XMOHS-Micrographic Surgery Physician
3207NP0225XPediatric Dermatology Physician
4207NI0002XClinical & Laboratory Dermatological Immunology Physician
5207N00000XDermatology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154374015
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY HOSPITAL DERMATOLOGY ASSOCIATES INC
Provider Business Mailing Address
First Line : 3605 WARRENSVILLE CENTER RD
Second Line : 1ST FLOOR
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5203
Country : US
Telephone Number : 216-286-6295
Fax Number : 216-286-6341
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1736
Country : US
Telephone Number : 216-844-8200
Fax Number :
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : JENNIFER BYRNE
Credential :
Telephone Number : 216-844-8992
Provider Enumeration Date : 05/19/2006
Last Update Date : 08/13/2008

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Directions to “UNIVERSITY HOSPITAL DERMATOLOGY ASSOCIATES INC ” Practice Location

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