Provider Demographics
NPI:1992717904
Name:DERMATOLOGY SERVICES INC.
Entity type:Organization
Organization Name:DERMATOLOGY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-895-4805
Mailing Address - Street 1:615 COPELAND MILL RD
Mailing Address - Street 2:SUITE 1 E
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8904
Mailing Address - Country:US
Mailing Address - Phone:614-895-4805
Mailing Address - Fax:
Practice Address - Street 1:615 COPELAND MILL RD
Practice Address - Street 2:SUITE 1 E
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8904
Practice Address - Country:US
Practice Address - Phone:614-895-4805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056491207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherIRS TAX ID #