Provider Demographics
NPI:1861407439
Name:DERMATOLOGY ASSOCIATES OF CLEVELAND, INC.
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF CLEVELAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-461-7001
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-461-7001
Mailing Address - Fax:440-461-7885
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:SUITE 510
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-461-7001
Practice Address - Fax:440-461-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0957924Medicaid
OHDE9265472Medicare ID - Type UnspecifiedMEDICARE GROUP #
OHA79740Medicare UPIN
OHA71084Medicare UPIN