Provider Demographics
NPI:1265297899
Name:OHIODERM HOLDING INC.
Entity type:Organization
Organization Name:OHIODERM HOLDING INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-943-0355
Mailing Address - Street 1:5775 PERIMETER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3224
Mailing Address - Country:US
Mailing Address - Phone:614-845-0418
Mailing Address - Fax:614-389-3841
Practice Address - Street 1:5775 PERIMETER DR STE 200
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3224
Practice Address - Country:US
Practice Address - Phone:614-845-0418
Practice Address - Fax:614-389-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty