Provider Demographics
NPI:1891214896
Name:DUCHARME DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:DUCHARME DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHARME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-650-2914
Mailing Address - Street 1:16349 SHERIDAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4675
Mailing Address - Country:US
Mailing Address - Phone:515-987-0333
Mailing Address - Fax:833-288-7944
Practice Address - Street 1:16349 SHERIDAN DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:515-987-0333
Practice Address - Fax:833-288-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-40967207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty