Organization
EASTSIDE DERMATOLOGY, INC.
Active
Organization
EASTSIDE DERMATOLOGY, INC.
Active
Other names
Eastside Dermatology & Skin Care Center, Eastside Dermatology of Hilla
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN J PARKS MD (PRESIDENT)
(614) 863-3222
Entity
Organization
Contact information
Practice address
150 TAYLOR STATION RD, SUITE 250, COLUMBUS, OH 43213
(614) 863-3222
(614) 863-4450
Mailing address
150 TAYLOR STATION RD, SUITE 250, COLUMBUS, OH 43213
(614) 863-3222
(614) 863-4450
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
35054686
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000118991
ALAN PARKS ANTHEM ID
OH
01
—
000000214662
STEPHANIE COTELL ANTHEM I
OH
05
—
0665856
—
OH
01
—
1215972484
YAHNA T SMITH CNP NPI
OH
01
—
1598751653
ALAN PARKS NPI
OH
01
—
1922093459
STEPHANIE COTELL NPI
OH
05
—
2285218
—
OH
Enumeration date
01/17/2007
Last updated
10/16/2008
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