Provider Demographics
NPI:1649515313
Name:DERMATOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEDVIS-LEFTICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-471-6405
Mailing Address - Street 1:1351 S COUNTY TRL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5105
Mailing Address - Country:US
Mailing Address - Phone:401-471-6405
Mailing Address - Fax:401-632-2842
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 302
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5105
Practice Address - Country:US
Practice Address - Phone:401-471-6405
Practice Address - Fax:401-632-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10175207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty