Provider Demographics
NPI:1619159183
Name:ASSOCIATED DERMATOLOGY, INC
Entity Type:Organization
Organization Name:ASSOCIATED DERMATOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CORDER
Authorized Official - Last Name:WOOFTER
Authorized Official - Suffix:
Authorized Official - Credentials:MDFAAD
Authorized Official - Phone:304-485-3834
Mailing Address - Street 1:1110 20TH ST.
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101
Mailing Address - Country:US
Mailing Address - Phone:304-485-3834
Mailing Address - Fax:304-422-4911
Practice Address - Street 1:1110 20TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2609
Practice Address - Country:US
Practice Address - Phone:304-485-3834
Practice Address - Fax:304-422-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVW00368442OtherMEDICARE INDIVIDUAL #
1780648287OtherNPI INDIVIDUAL #
WVAS9264011OtherMEDICARE GROUP ID#