Provider Demographics
NPI:1316233158
Name:OHIO PREMIER DERMATOLOGY, LLC
Entity type:Organization
Organization Name:OHIO PREMIER DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SARSAMA NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-256-5422
Mailing Address - Street 1:44 KINTNER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9368
Mailing Address - Country:US
Mailing Address - Phone:740-965-0855
Mailing Address - Fax:740-965-0836
Practice Address - Street 1:44 KINTNER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9368
Practice Address - Country:US
Practice Address - Phone:740-965-0855
Practice Address - Fax:740-965-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009063207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty