Provider Demographics
NPI:1457326514
Name:HMT DERMATOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:HMT DERMATOLOGY ASSOCIATES INC
Other - Org Name:TRILLIUM CREEK DERMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOROK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-725-0569
Mailing Address - Street 1:5783 WOOSTER PIKE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-725-0569
Mailing Address - Fax:330-662-0258
Practice Address - Street 1:5783 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-725-0569
Practice Address - Fax:330-662-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061331Medicaid
OH9295262OtherMEDICARE GROUP