Provider Demographics
NPI:1558033712
Name:YELLOWSTONE DERMATOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:YELLOWSTONE DERMATOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-409-7584
Mailing Address - Street 1:1336 RIVIERA PL
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-3233
Mailing Address - Country:US
Mailing Address - Phone:305-409-7584
Mailing Address - Fax:
Practice Address - Street 1:178 S 32ND ST W STE 3
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6889
Practice Address - Country:US
Practice Address - Phone:305-409-7584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty