Provider Demographics
NPI:1972797231
Name:APPALACHIAN SPRING DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:APPALACHIAN SPRING DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SANTMYIRE-ROSENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:304-368-0111
Mailing Address - Street 1:100 VILLAGE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7986
Mailing Address - Country:US
Mailing Address - Phone:304-368-0111
Mailing Address - Fax:304-368-0411
Practice Address - Street 1:100 VILLAGE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-7986
Practice Address - Country:US
Practice Address - Phone:304-368-0111
Practice Address - Fax:304-368-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP9355571Medicare PIN
I35386Medicare UPIN