Provider Demographics
NPI:1821864844
Name:AT HOME DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:AT HOME DERMATOLOGY PLLC
Other - Org Name:@ HOME DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CALL
Authorized Official - Last Name:BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:435-770-5119
Mailing Address - Street 1:311 E 300 S
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9464
Mailing Address - Country:US
Mailing Address - Phone:435-770-5119
Mailing Address - Fax:
Practice Address - Street 1:311 E 300 S
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9464
Practice Address - Country:US
Practice Address - Phone:435-770-5119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty