Provider Demographics
NPI:1386706125
Name:DERMATOLOGY ASSOCIATES OF OHIO, LLC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-974-5247
Mailing Address - Street 1:6136 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1453
Mailing Address - Country:US
Mailing Address - Phone:937-974-5247
Mailing Address - Fax:
Practice Address - Street 1:8100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1702
Practice Address - Country:US
Practice Address - Phone:937-974-5247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060161207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty