Provider Demographics
NPI:1750589354
Name:ARLINGTON DERMATOLOGY CLINIC, PA
Entity type:Organization
Organization Name:ARLINGTON DERMATOLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-265-1356
Mailing Address - Street 1:801 ROAD TO SIX FLAGS W STE 139
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2600
Mailing Address - Country:US
Mailing Address - Phone:817-265-1356
Mailing Address - Fax:
Practice Address - Street 1:801 ROAD TO SIX FLAGS W STE 139
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2600
Practice Address - Country:US
Practice Address - Phone:817-265-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6729174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF64477Medicare UPIN
TX00N86FMedicare ID - Type Unspecified