Provider Demographics
NPI:1568414266
Name:ADVANCED DERMATOLOGY INC
Entity Type:Organization
Organization Name:ADVANCED DERMATOLOGY INC
Other - Org Name:ADVANCED DERMATOLOGY & COSMETIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-425-7600
Mailing Address - Street 1:PO BOX 932930
Mailing Address - Street 2:ADVANCED DERMATOLOGY, INC.
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-2930
Mailing Address - Country:US
Mailing Address - Phone:330-425-7600
Mailing Address - Fax:
Practice Address - Street 1:8940 DARROW RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2110
Practice Address - Country:US
Practice Address - Phone:330-425-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2082213Medicaid
CI9506OtherMEDICARE RAILROAD
OH9266601Medicare PIN