Provider Demographics
NPI:1750437646
Name:CINCINNATI DERMATOLOGY, INC.
Entity type:Organization
Organization Name:CINCINNATI DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-662-2500
Mailing Address - Street 1:2859 BOUDINOT AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-1606
Mailing Address - Country:US
Mailing Address - Phone:513-662-2500
Mailing Address - Fax:513-662-2511
Practice Address - Street 1:2859 BOUDINOT AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-1606
Practice Address - Country:US
Practice Address - Phone:513-662-2500
Practice Address - Fax:513-662-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058847207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty