Provider Demographics
NPI:1134698103
Name:GLOBAL DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:GLOBAL DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-505-0105
Mailing Address - Street 1:6071 E WOODMEN RD STE 230
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2607
Mailing Address - Country:US
Mailing Address - Phone:719-505-0105
Mailing Address - Fax:719-284-4626
Practice Address - Street 1:6071 E WOODMEN RD STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2607
Practice Address - Country:US
Practice Address - Phone:719-505-0105
Practice Address - Fax:719-284-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty