Provider Demographics
NPI:1104089747
Name:DURHAM, ALISON BATES (MD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:BATES
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:MARIE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5800 LANDERBROOK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6510
Mailing Address - Country:US
Mailing Address - Phone:440-443-0423
Mailing Address - Fax:
Practice Address - Street 1:4124 MUNSON ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4804
Practice Address - Country:US
Practice Address - Phone:440-443-0423
Practice Address - Fax:440-443-0414
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093769207N00000X, 207ND0101X, 207NS0135X
OH35.143535207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology