Provider Demographics
NPI:1194048470
Name:ELITE DERMATOLOGY OF COLUMBUS
Entity type:Organization
Organization Name:ELITE DERMATOLOGY OF COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-781-1993
Mailing Address - Street 1:596 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5654
Mailing Address - Country:US
Mailing Address - Phone:828-399-9163
Mailing Address - Fax:828-586-8209
Practice Address - Street 1:1830 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1809
Practice Address - Country:US
Practice Address - Phone:614-781-1993
Practice Address - Fax:614-754-8924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060930207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9389541Medicare PIN