Provider Demographics
NPI:1447395579
Name:MID OHIO DERMATOLOGY
Entity Type:Organization
Organization Name:MID OHIO DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-442-0100
Mailing Address - Street 1:4900 GETTYSBURG RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2520
Mailing Address - Country:US
Mailing Address - Phone:614-442-0100
Mailing Address - Fax:614-442-7753
Practice Address - Street 1:4900 GETTYSBURG RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2520
Practice Address - Country:US
Practice Address - Phone:614-442-0100
Practice Address - Fax:614-442-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1127180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9309451Medicare ID - Type UnspecifiedGROUP NUMBER