MEDICARE: OHIO MEDICAL SPECIALISTS, LLC

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	35.099878	OH

General Provider Information

NPI Number	:	1902285943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO MEDICAL SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	22901 HALBURTON RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-3962
Country	:	US
Telephone Number	:	508-410-2586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 NILES CORTLAND RD NE
Second Line	:	WEXFORD CENTER UNIT 10
City	:	WARREN
State	:	OH
Zip	:	44484-1077
Country	:	US
Telephone Number	:	508-410-2586
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. MORGAN HOTT
Credential	:	M.D.
Telephone Number	:	508-410-2586

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	05/22/2015

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