Provider Demographics
NPI:1538204870
Name:DERMATOLOGY, PC
Entity type:Organization
Organization Name:DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-664-3292
Mailing Address - Street 1:330 N WABASH AVE
Mailing Address - Street 2:#360
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-664-3292
Mailing Address - Fax:765-662-7560
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:#360
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:47342-9999
Practice Address - Country:US
Practice Address - Phone:765-664-3292
Practice Address - Fax:765-662-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003832A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN296140Medicare PIN