Provider Demographics
NPI:1831227289
Name:THE DERMATOLOGY AND SKIN CANCER CLINIC OF ALASKA
Entity type:Organization
Organization Name:THE DERMATOLOGY AND SKIN CANCER CLINIC OF ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANNAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-262-7546
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-0780
Mailing Address - Country:US
Mailing Address - Phone:907-262-7546
Mailing Address - Fax:907-262-7599
Practice Address - Street 1:180 E BELUGA AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8002
Practice Address - Country:US
Practice Address - Phone:907-262-7546
Practice Address - Fax:907-262-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD16711Medicaid
AKK152458Medicare PIN