Provider Demographics
NPI:1144380502
Name:OHIO VALLEY DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:OHIO VALLEY DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUBEN
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:304-232-7151
Mailing Address - Street 1:1038 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2912
Mailing Address - Country:US
Mailing Address - Phone:304-232-7151
Mailing Address - Fax:304-232-6128
Practice Address - Street 1:1038 MARKET ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2912
Practice Address - Country:US
Practice Address - Phone:304-232-7151
Practice Address - Fax:304-232-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11124207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5900115Medicaid
WV1992790158OtherNATIONAL PROVIDER NUMBER
WV1992790158OtherNATIONAL PROVIDER NUMBER
WVRU0432055Medicare ID - Type Unspecified