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LIVE OAK DERMATOLOGY PC NPI 1609654466


NPI Information

NPI: 1609654466
Provider Name: LIVE OAK DERMATOLOGY PC
Classification: Dermatology - 207ND0101X
Entity Type: Organization

Specialization: MOHS-Micrographic Surgery

CLIA Number: 39D2301108

Address:
7176 W RIDGE RD
FAIRVIEW, PA
ZIP 16415
Phone: (814) 413-7997
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LIVE OAK DERMATOLOGY PC is a mohs-micrographic surgery dermatology in Fairview, PA. 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. LIVE OAK DERMATOLOGY PC NPI is 1609654466. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7176 W RIDGE RD
FAIRVIEW, PA
ZIP 16415-027
Phone: (814) 413-7997
Fax: (814) 413-7998

The provider's authorized official is Kristyn Billings .
The authorized official title is Credentialing and has the following contact phone number (412) 655-4362.

The CLIA number assigned to this NPI record is 39D2301108 - practitioner other with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 9/21/2023 and was last updated on 9/21/2023.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207ND0101XDermatologyMOHS-Micrographic SurgeryYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1OS015047OTHERPENNSYLVANIASTATE LIC

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: 5/5/2024

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