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Organization
DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC
Active
Organization
DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIE MASSA M.D. (MANAGING PARTNER)
(859) 263-4444
Entity
Organization
Contact information
Practice address
250 FOUNTAIN CT, LEXINGTON, KY 40509-1888
(859) 263-4444
(859) 543-8867
Mailing address
250 FOUNTAIN CT, LEXINGTON, KY 40509-1888
(859) 263-4444
(859) 543-8867
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
300149
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000304454
ANTHEM BLUE CROSS & BLUE SHIELD
KY
01
—
000000304454
ANTHEM
—
Enumeration date
01/22/2007
Last updated
10/30/2008
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