ASSOCIATES IN DERMATOLOGY, INC.

Provider Demographics

• NPI: 1396852133
• Name: ASSOCIATES IN DERMATOLOGY, INC.
• Entity Type: Organization
• Organization Name: ASSOCIATES IN DERMATOLOGY, INC.
• Authorized Official - Title/Position: PHYSICIAN/PARTNER
• Authorized Official - First Name: PAUL
• Authorized Official - Middle Name: G
• Authorized Official - Last Name: HAZEN
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 440-482-8323
• Mailing Address - Street 1: 26908 DETROIT ROAD
• Mailing Address - Street 2: SUITE 103
• Mailing Address - City: WESTLAKE
• Mailing Address - State: OH
• Mailing Address - Zip Code: 44145-2399
• Mailing Address - Country: US
• Mailing Address - Phone: 440-482-8323
• Mailing Address - Fax: 440-808-1606
• Practice Address - Street 1: 26908 DETROIT RD
• Practice Address - Street 2: SUITE 103
• Practice Address - City: WESTLAKE
• Practice Address - State: OH
• Practice Address - Zip Code: 44145-2398
• Practice Address - Country: US
• Practice Address - Phone: 440-482-8323
• Practice Address - Fax: 440-808-1718
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-25
• Last Update Date: 2020-01-08

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207N00000X	Allopathic & Osteopathic Physicians	Dermatology		Group - Multi-Specialty
No	207ND0900X	Allopathic & Osteopathic Physicians	Dermatology	Dermatopathology	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OH	0400551	Medicaid
OH	0466339	Medicaid
OH	0356092	Medicaid
OH	0785995	Medicaid
OH	0204540	Medicaid
OH	2253654	Medicaid
OH	2350370	Medicaid
	0499042	Medicare PIN
OH	2350370	Medicaid
	0656634	Medicare PIN
	0437022	Medicare PIN
OH	0400551	Medicaid
OH	0204540	Medicaid
	4053321	Medicare PIN
	9931262	Medicare PIN
	0437023	Medicare PIN
	4083471	Medicare PIN
	0656631	Medicare PIN
	0499043	Medicare PIN
	0380644	Medicare PIN
	0656635	Medicare PIN
OH	0785995	Medicaid
	4053322	Medicare PIN
	9931261	Medicare PIN