MEDICARE: SICARD 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	174400000X	Specialist

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

General Provider Information

NPI Number	:	1932123544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SICARD DERMATOLOGY, INC.

Provider Business Mailing Address
First Line	:	4825 MUNSON STREET NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3614
Country	:	US
Telephone Number	:	330-497-7525
Fax Number	:	330-497-2687

Provider Business Practice Location Address
First Line	:	4825 MUNSON STREET NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3614
Country	:	US
Telephone Number	:	330-497-7525
Fax Number	:	330-497-2687

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FAUSTO A. SICARD
Credential	:	M.D.
Telephone Number	:	330-497-7525

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/16/2026

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