Provider Demographics
NPI:1821273681
Name:DERMATOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES, P.C.
Other - Org Name:DERMATOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HONL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-478-7747
Mailing Address - Street 1:4133 30TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-478-7747
Mailing Address - Fax:701-478-7748
Practice Address - Street 1:4133 30TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-478-7747
Practice Address - Fax:701-478-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN026092400Medicaid
ND12984Medicaid
MN246K7DEOtherBLUE SHIELD OF MN
ND06218001OtherBLUE SHIELD OF ND
NDN711273Medicare Oscar/Certification