Organization
DERMATOLOGIC SURGERY CENTER OF NORTHEAST OHIO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER POPOVSKY MD (PRESIDENT)
(330) 239-4350
Entity
Organization
Contact information
Practice address
1133 MEDINA RD, SUITE 100, MEDINA, OH 44256-0000
(330) 238-4350
(330) 239-4584
Mailing address
1133 MEDINA RD, SUITE 100, MEDINA, OH 44256
(330) 239-4350
(330) 239-4584
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
35076146P
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2190785
—
OH
Enumeration date
12/13/2011
Last updated
02/27/2012
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