Provider Demographics
NPI:1407249071
Name:CLEVELAND DERMATOLOGY GROUP LLC
Entity Type:Organization
Organization Name:CLEVELAND DERMATOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:216-702-2687
Mailing Address - Street 1:2001 CROCKER RD STE 500
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6967
Mailing Address - Country:US
Mailing Address - Phone:440-617-1522
Mailing Address - Fax:440-617-1523
Practice Address - Street 1:2001 CROCKER RD STE 500
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6967
Practice Address - Country:US
Practice Address - Phone:440-617-1522
Practice Address - Fax:440-617-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty