Provider Demographics
NPI:1720204514
Name:BARRETT & GEISS DERMATOLOGY INC
Entity Type:Organization
Organization Name:BARRETT & GEISS DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-344-1415
Mailing Address - Street 1:112 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3307
Mailing Address - Country:US
Mailing Address - Phone:740-687-1177
Mailing Address - Fax:740-344-5661
Practice Address - Street 1:2000 NEWARK GRANVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9135
Practice Address - Country:US
Practice Address - Phone:740-587-3376
Practice Address - Fax:740-587-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005696G174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0190289Medicaid
E89015Medicare UPIN
OH0190289Medicaid