Provider Demographics
NPI:1326263799
Name:SKIN SOLUTIONS
Entity Type:Organization
Organization Name:SKIN SOLUTIONS
Other - Org Name:MADISON DERMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-348-1000
Mailing Address - Street 1:2510 SANDCREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3047
Mailing Address - Country:US
Mailing Address - Phone:812-348-1000
Mailing Address - Fax:
Practice Address - Street 1:2510 SANDCREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3047
Practice Address - Country:US
Practice Address - Phone:812-348-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN065504OtherSIHO