Provider Demographics
NPI:1033205216
Name:DERMATOLOGY ASSOCIATES OF YOUNGSTOWN INC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF YOUNGSTOWN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-726-9141
Mailing Address - Street 1:7430 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-726-9141
Mailing Address - Fax:330-726-7140
Practice Address - Street 1:7430 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-726-9141
Practice Address - Fax:330-726-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032735H207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279210Medicaid
OH0784889Medicaid
OH0279210Medicaid
OH9931222Medicare PIN
A75343Medicare UPIN