Provider Demographics
NPI:1699708438
Name:AKRON DERMATOLOGY, INC.
Entity type:Organization
Organization Name:AKRON DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KERN
Authorized Official - Last Name:MOSTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-665-1161
Mailing Address - Street 1:566 WHITE POND DR
Mailing Address - Street 2:STE E
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1116
Mailing Address - Country:US
Mailing Address - Phone:330-535-7100
Mailing Address - Fax:330-535-2600
Practice Address - Street 1:566 WHITE POND DR
Practice Address - Street 2:STE E
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1116
Practice Address - Country:US
Practice Address - Phone:330-535-7100
Practice Address - Fax:330-535-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064845M207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EC9316181Medicare ID - Type Unspecified