MEDICARE: ENCORE DERMATOLOGY, 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

General Provider Information

NPI Number	:	1912220799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCORE DERMATOLOGY, INC

Provider Business Mailing Address
First Line	:	4900 GETTYSBURG RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2520
Country	:	US
Telephone Number	:	614-442-1012
Fax Number	:	614-442-7726

Provider Business Practice Location Address
First Line	:	4900 GETTYSBURG RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2520
Country	:	US
Telephone Number	:	614-442-0100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GWYN R LONDEREE
Credential	:	M.D.
Telephone Number	:	614-442-1012

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	06/06/2024

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Directions to “ENCORE DERMATOLOGY, INC ” Practice Location

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