Provider Demographics
NPI:1134451446
Name:AKRON DERMATOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:AKRON DERMATOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIBECCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-836-0201
Mailing Address - Street 1:3085 W MARKET ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3620
Mailing Address - Country:US
Mailing Address - Phone:330-836-0201
Mailing Address - Fax:330-836-9406
Practice Address - Street 1:3085 W MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3620
Practice Address - Country:US
Practice Address - Phone:330-836-0201
Practice Address - Fax:330-836-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085787207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2583619Medicaid
OHLI4159351OtherMEDICARE PROVIDER NUMBER