Provider Demographics
NPI:1467526731
Name:DERMATOLOGY SPECIALISTS OF GREATER CINCINNATI INC
Entity Type:Organization
Organization Name:DERMATOLOGY SPECIALISTS OF GREATER CINCINNATI INC
Other - Org Name:LEE J VESPER MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-482-8968
Mailing Address - Street 1:7794 5 MILE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2368
Mailing Address - Country:US
Mailing Address - Phone:513-231-1575
Mailing Address - Fax:513-232-8490
Practice Address - Street 1:7794 5 MILE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2368
Practice Address - Country:US
Practice Address - Phone:513-231-1575
Practice Address - Fax:513-232-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLE9254171Medicare ID - Type Unspecified