Provider Demographics
NPI:1033444997
Name:DERMATOLOGY & SKIN CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:DERMATOLOGY & SKIN CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A L
Authorized Official - Last Name:MUENNICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:513-770-3263
Mailing Address - Street 1:PO BOX 9110
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9110
Mailing Address - Country:US
Mailing Address - Phone:513-770-3263
Mailing Address - Fax:513-770-3295
Practice Address - Street 1:7249 LIBERTY WAY STE 100
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1704
Practice Address - Country:US
Practice Address - Phone:513-770-3263
Practice Address - Fax:513-770-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9387301Medicare PIN