DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC (NPI# 1205104601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205104601 |
| Entity Type | Organization |
| Organization Name | DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC |
| Practice Address |
1133 Medina Rd Suite 100 Medina OH 44256-0000 |
| Mailing Address |
1133 Medina Rd Suite 100 Medina OH 44256 |
| Practice Telephone | 3302384350 |
| Practice Fax Number | 3302394584 |
| Mailing Telephone | 3302394350 |
| Mailing Fax Number | 3302394584 |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2012-02-27 |
| Authorized Official Name | JENNIFER POPOVSKY (PRESIDENT) |
| Authorized Official Telephone | 3302394350 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
35076146P | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2190785 | 05 |
| Street Address |
1133 MEDINA RD SUITE 100 |
| City | MEDINA |
| State | OH |
| Zip Code | 44256-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225022791 | Galaxy Medical Products, Inc. | Durable Medical Equipment & Medical Supplies | 1133 Medina Rd, Ste 800, Medina, OH 44256-5914 | 2005-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215577408 | Phil Mcclelland | Counselor | 520 Miller Dr, Medina, OH 44256 | 2020-01-15 |
| 1619519444 | Lauren Marie Blakney | Nurse Practitioner | 970 E Washington St., Medina, OH 44256 | 2019-10-14 |
| 1558922286 | Jennifer Sue Arhin | Nurse Practitioner | 807 E Washington St., Ste 220, Medina, OH 44256 | 2019-06-24 |
| 1891263927 | Jena Christine Palmer | Nurse Practitioner | 817 E Washington Street, Medina, OH 44256 | 2018-11-07 |
| 1154849891 | Janelle Liggett-schultz | Licensed Practical Nurse | 8170 Coon Club Rd, Medina, OH 44256 | 2017-09-01 |
| 1942725478 | Amanda Kay Byrne | Registered Nurse | 1000 Concord Dr., Medina, OH 44256 | 2017-08-05 |
| 1821526922 | Melissa Marie Rutti | Nurse Practitioner | 111 Reagan Pkwy, Medina, OH 44256 | 2017-06-01 |
| 1992238919 | Lisa Scherler | Speech-Language Pathologist | 3880 Ridge Rd., Medina, OH 44256 | 2017-04-06 |
| 1770026502 | Victoria Lee Ayala | Speech-Language Pathologist | 390 Fair Street, Berea, OH 44256 | 2016-11-28 |
| 1982076626 | Finding Your Identity LLC | Community/Behavioral Health | 124 West Lafayette Road, Suite 100, Medina, OH 44256 | 2015-10-21 |
| Find all providers in zip 44256 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952307324 | Jennifer L Popovsky | Dermatology | 1133 Medina Rd Ste 100, Medina, OH 44256-5913 | 2005-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689973638 | Apex Dermatology and Skin Surgery Center LLC | Dermatology | 7580 Auburn Road, Suite 301, Tripoint Medical Center, Physician Pavillion, Painesville, OH 44077 | 2011-03-16 |
| 1235442211 | Dermatology & Surgery of Southern Ohio, Inc. | Dermatology | 7132 Cincinnati Dayton Rd, Suite 200, Liberty Townshp, OH 45069-1775 | 2010-07-20 |
| 1619070224 | West Ohio Dermatology, Inc. | Dermatology | 750 W High St Ste 300, Lima, OH 45801-2967 | 2006-09-07 |
| 1912910803 | Harry Michael Humeniuk | Dermatology | 4935 Harroun Rd, Sylvania, OH 43560-2107 | 2006-08-14 |
| 1891783494 | Henry Michael Duke | Dermatology | 6210 N Main St, Dayton, OH 45415-3111 | 2005-10-10 |
| 1356884837 | Bravia Dermatology Group, LLC | Dermatology | 2000 Regency Ct, Suite #201, Toledo, OH 43623-3090 | 2016-12-01 |
| 1932592698 | Allied Dermatology and Skin Surgery, LLC | Dermatology | 3624 W Market St Ste 101, Fairlawn, OH 44333-4510 | 2015-03-05 |
| 1508197112 | Ohio Skin Cancer Institute LLC | Dermatology | 602 Morrison Rd, Gahanna, OH 43230-5342 | 2010-01-21 |
| 1942433065 | Columbus Skin Surgery Center, Inc. | Dermatology | 6670 Perimeter Dr, Suite 260, Dublin, OH 43016-8056 | 2009-08-25 |
| 1801030598 | Rem Jr., Inc. | Dermatology | 3632 W Market St, Suite 102, Fairlawn, OH 44333-2494 | 2009-04-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.