Provider Demographics
NPI:1437226636
Name:DERMATOLOGY PARTNERS, INC.
Entity Type:Organization
Organization Name:DERMATOLOGY PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-626-6700
Mailing Address - Street 1:2500 W STRUB RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5390
Mailing Address - Country:US
Mailing Address - Phone:419-626-6700
Mailing Address - Fax:419-626-6710
Practice Address - Street 1:2500 W STRUB RD
Practice Address - Street 2:SUITE 330
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5390
Practice Address - Country:US
Practice Address - Phone:419-626-6700
Practice Address - Fax:419-626-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070175207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH168702OtherANTHEM BLUE CROSS
OH2364481Medicaid
OHCN 7786OtherRR MEDICARE
OHCN 7786OtherRR MEDICARE