Provider Demographics
NPI:1972904860
Name:THE PARKER SKIN & AESTHETIC CLININ
Entity Type:Organization
Organization Name:THE PARKER SKIN & AESTHETIC CLININ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-464-7333
Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4338
Mailing Address - Country:US
Mailing Address - Phone:216-464-7333
Mailing Address - Fax:216-464-2696
Practice Address - Street 1:3733 PARK EAST DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4338
Practice Address - Country:US
Practice Address - Phone:216-464-7333
Practice Address - Fax:216-464-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16492-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty