Provider Demographics
NPI:1962578393
Name:DERMATOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-872-0777
Mailing Address - Street 1:12780 ROACHTON ROAD
Mailing Address - Street 2:#1
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551
Mailing Address - Country:US
Mailing Address - Phone:419-872-0777
Mailing Address - Fax:419-872-2369
Practice Address - Street 1:12780 ROACHTON ROAD
Practice Address - Street 2:#1
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-872-0777
Practice Address - Fax:419-872-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049683207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9274691Medicare ID - Type UnspecifiedGROUP BILLING NUMBER
OH070003347Medicare ID - Type UnspecifiedRAILROAD GROUP NUMBER