MEDICARE: NORTHCOAST 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
1	207N00000X	Dermatology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CD6030	OTHER	OH	RAILROAD MEDICARE SAG
4	CC5264	OTHER	OH	RAILROAD MEDICARE-INDEP

Other Identifiers

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

General Provider Information

NPI Number	:	1750347480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHCOAST DERMATOLOGY ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	4807 ROCKSIDE RD STE 100
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2188
Country	:	US
Telephone Number	:	216-524-4009
Fax Number	:	216-524-7933

Provider Business Practice Location Address
First Line	:	4807 ROCKSIDE RD STE 100
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2188
Country	:	US
Telephone Number	:	216-524-4009
Fax Number	:	216-524-7933

Authorized Official
Title or Position	:	DERMATOLOGIST / OWNER
Name	:	DR. RACHEL MISTUR
Credential	:	MD
Telephone Number	:	216-524-4009

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	05/12/2026

Similar Medicare Providers

1780994517 — NORTHCOAST DERMATOLOGY ASSOCIATES, INC.
Practice Location Address:

4807 ROCKSIDE RD STE 100
INDEPENDENCE, OH
44131-2188

Practice Phone: 216-524-4009
Practice Fax: 216-524-7933

1033504501 — DR. RACHEL MISTUR MD
Practice Location Address:

4807 ROCKSIDE RD STE 100
INDEPENDENCE, OH
44131-2188

Practice Phone: 216-524-4009
Practice Fax: 216-524-7933

1194416792 — STEPHANIE WALLACE APRN CNP
Practice Location Address:

4807 ROCKSIDE RD STE 100
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44131-2188

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1417420456 — GREENBROOK TMS CLEVELAND LLC
Practice Location Address:

4807 ROCKSIDE RD STE 450
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1851009203 — ALLISON ANN PHELPS PT, DPT
Practice Location Address:

5001 ROCKSIDE RD
INDEPENDENCE, OH
44131-2172

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1518897503 — TODD LEE BARGER
Practice Location Address:

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Directions to “NORTHCOAST DERMATOLOGY ASSOCIATES, INC. ” Practice Location

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