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DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC NPI 1205104601


NPI Information

NPI: 1205104601
Provider Name: DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 36D2032981

Address:
1133 MEDINA RD
SUITE 100
MEDINA, OH
ZIP 44256
Phone: (330) 238-4350
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DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC is a mohs-micrographic surgery dermatology in Medina, OH. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC NPI is 1205104601. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1133 MEDINA RD
SUITE 100
MEDINA, OH
ZIP 44256-000
Phone: (330) 238-4350
Fax: (330) 239-4584

The provider's authorized official is Jennifer Popovsky .
The authorized official title is President and has the following contact phone number (330) 239-4350.

The CLIA number assigned to this NPI record is 36D2032981 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/13/2011 and was last updated on 2/27/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207ND0101XDermatologyMOHS-Micrographic Surgery35076146POHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12190785MEDICAIDOHIO
2PO4032241MEDICARE PINOHIO
3H24383MEDICARE UPINOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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