Provider Demographics
NPI:1366504656
Name:DERMATOLOGY AND COSMETIC SURGERY OF DUBLIN, INC
Entity Type:Organization
Organization Name:DERMATOLOGY AND COSMETIC SURGERY OF DUBLIN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-761-7705
Mailing Address - Street 1:6905 HOSPITAL DRIVE ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016
Mailing Address - Country:US
Mailing Address - Phone:614-761-7705
Mailing Address - Fax:614-734-9570
Practice Address - Street 1:6905 HOSPITAL DRIVE ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:614-761-7705
Practice Address - Fax:614-734-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005944207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF74787Medicare UPIN
OH9364921Medicare PIN