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Organization

ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC

Active
Other names
ADVANCED DERMATOLOGY OF NORTH CENTRAL OHIO INC
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHRIST JOHN TICORAS M.D. (OWNER/PRESIDENT)
(419) 756-1600
Entity
Organization

Contact information

Practice address
770 BALGREEN DR, STE 201, MANSFIELD, OH 44906-4106
(419) 756-1600
(419) 775-1196
Mailing address
770 BALGREEN DR., STE. 201, MANSFIELD, OH 44906-4106
(419) 756-1600
(419) 775-1196

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
207NS0135X
Procedural Dermatology Physician
Primary
35063717T
OH
207NS0135X
Procedural Dermatology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2251316
OH
Enumeration date
07/30/2006
Last updated
08/21/2012
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