Provider Demographics
NPI:1992373062
Name:CINCYSKIN MEDICAL AND COSMETIC DERMATOLOGY LLC
Entity Type:Organization
Organization Name:CINCYSKIN MEDICAL AND COSMETIC DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-681-0104
Mailing Address - Street 1:8300 KENWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2294
Mailing Address - Country:US
Mailing Address - Phone:513-393-9122
Mailing Address - Fax:513-715-0003
Practice Address - Street 1:8300 KENWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2294
Practice Address - Country:US
Practice Address - Phone:513-393-9122
Practice Address - Fax:513-715-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty