Provider Demographics
NPI:1356683999
Name:LEO DERMATOLOGY LLC
Entity Type:Organization
Organization Name:LEO DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:GROOMS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:937-863-0083
Mailing Address - Street 1:7185 DAYTON SPRINGFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-1467
Mailing Address - Country:US
Mailing Address - Phone:937-863-0083
Mailing Address - Fax:
Practice Address - Street 1:7185 DAYTON SPRINGFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1467
Practice Address - Country:US
Practice Address - Phone:937-863-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH263353207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty