Organization
ADVANCED MEDICAL GROUP
Active
Other names
Advanced Cosmetic Dermatology, Advanced Dermatolgoy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARINA IGOREVNA LUPAS (MANAGER)
(907) 691-4977
Entity
Organization
Contact information
Practice address
135 W DIMOND BLVD STE 104C, ANCHORAGE, AK 99515-1907
(907) 691-4977
(907) 313-7450
Mailing address
PO BOX 230508, ANCHORAGE, AK 99523-0508
(907) 691-4977
(907) 313-7450
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
07/21/2020
Last updated
01/28/2022
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