Provider Demographics
NPI:1285697060
Name:PHOENIX DERMATOLOGY LTD
Entity type:Organization
Organization Name:PHOENIX DERMATOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-244-8886
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-0155
Mailing Address - Country:US
Mailing Address - Phone:412-826-1065
Mailing Address - Fax:412-826-1491
Practice Address - Street 1:4340 FULTON ROAD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2824
Practice Address - Country:US
Practice Address - Phone:330-244-8886
Practice Address - Fax:330-244-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPH9350271Medicare PIN