Provider Demographics
NPI:1033203815
Name:DERMATOLOGY INC
Entity Type:Organization
Organization Name:DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-926-3739
Mailing Address - Street 1:875 AIRPORT PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1085
Mailing Address - Country:US
Mailing Address - Phone:317-926-3739
Mailing Address - Fax:317-921-7478
Practice Address - Street 1:13250 HAZEL DELL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8527
Practice Address - Country:US
Practice Address - Phone:317-926-3739
Practice Address - Fax:317-921-7478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DERMATOLOGY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2022-10-05
Deactivation Date:2022-08-19
Deactivation Code:
Reactivation Date:2022-10-05
Provider Licenses
StateLicense IDTaxonomies
IN207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200165980AMedicaid
IN145370Medicare PIN