Provider Demographics
NPI:1427007236
Name:DERMATOLOGY SPECIALISTS OF NORTHERN KENTUCKY PSC
Entity Type:Organization
Organization Name:DERMATOLOGY SPECIALISTS OF NORTHERN KENTUCKY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-341-9588
Mailing Address - Street 1:215 THOMAS MORE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3498
Mailing Address - Country:US
Mailing Address - Phone:859-341-9588
Mailing Address - Fax:859-341-0078
Practice Address - Street 1:215A THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3498
Practice Address - Country:US
Practice Address - Phone:859-341-9588
Practice Address - Fax:859-341-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty