NPI 1831187764 · live from the CMS NPI Registry
Optima Dermatology LLC
Dermatology in Boardman, OH. National Provider Identifier 1831187764, active.
NPI record
| NPI | 1831187764 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 987 Boardman Canfield Rd, Boardman, OH 44512 |
| Practice phone | 330-965-8760 |
| Mailing address | 111 New Hampshire Ave Ste 2, Portsmouth, NH 03801 |
| Enumerated | October 13, 2005 |
| Last updated | July 1, 2024 |
| Authorized official | John Bernat, Authorized Official |
| Other names | Advanced Dermatology And Skin Cancer Center LLC |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Specialist | 174400000X | — |
| Dermatology primary | 207N00000X | — |
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | — |
| Dermatology, Dermatopathology | 207ND0900X | — |
| Pathology, Anatomic Pathology | 207ZP0101X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.