Provider Demographics
NPI:1801302047
Name:DERMATOLOGY ASSOCIATES OF MID-OHIO
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF MID-OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-389-0618
Mailing Address - Street 1:1063 HARDING MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6365
Mailing Address - Country:US
Mailing Address - Phone:740-244-8550
Mailing Address - Fax:740-751-4584
Practice Address - Street 1:1063 HARDING MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-244-8550
Practice Address - Fax:740-751-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005471207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty