Provider Demographics
NPI:1609894575
Name:PARKER SKIN & AESTHETIC CLINIC INC.
Entity Type:Organization
Organization Name:PARKER SKIN & AESTHETIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-464-7333
Mailing Address - Street 1:3737 PARK EAST DR STE 109
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4329
Mailing Address - Country:US
Mailing Address - Phone:216-464-7333
Mailing Address - Fax:216-342-5462
Practice Address - Street 1:3733 PARK EAST DR
Practice Address - Street 2:SUITE #104
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4338
Practice Address - Country:US
Practice Address - Phone:216-464-7333
Practice Address - Fax:216-464-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058810207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2081509Medicaid
OH2081509Medicaid
OHDE9284823Medicare ID - Type Unspecified