MEDICARE: DERMATOLOGY & AESTHETIC CARE 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

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	:	1962795302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY & AESTHETIC CARE LLC

Provider Business Mailing Address
First Line	:	1299 E ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2658
Country	:	US
Telephone Number	:	937-436-1117
Fax Number	:	937-436-9576

Provider Business Practice Location Address
First Line	:	1299 E ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2658
Country	:	US
Telephone Number	:	937-436-1117
Fax Number	:	937-436-9576

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA A DICKERSON
Credential	:	MD
Telephone Number	:	937-436-1117

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	10/27/2014

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1336132950 — PATRICIA A DICKERSON MD
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1299 E ALEX BELL RD
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45459-2658

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Practice Fax: 937-436-9576

1972558435 — KATHERINE LYNN FLANDERS N.P.
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1215041041 — PATRICIA A. DICKERSON MD
Practice Location Address:

1299 E ALEX BELL RD
CENTERVILLE, OH
45459-2658

Practice Phone: 937-436-1117
Practice Fax: 937-436-9576

1497906234 — SARAH A BALLARD PA-C
Practice Location Address:

1235 E ALEX BELL RD
CENTERVILLE, OH
45459-2658

Practice Phone: 937-435-6400
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1750525473 — MS. EMILY SUZANNE MONROE PA-C
Practice Location Address:

1299 E ALEX BELL RD
CENTERVILLE, OH
45459-2658

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Practice Fax: 937-436-9576

1265866362 — MS. AMY M BUSCHUR FNP
Practice Location Address:

1299 E ALEX BELL RD
CENTERVILLE, OH
45459-2658

Practice Phone: 937-436-1117
Practice Fax: 937-436-9576

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