Organization
MADISON DERMATOLOGY LLC
Active
Organization
MADISON DERMATOLOGY LLC
Active
Other names
skin solutions llc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDUARDO GABRIEL RIVERA M.D. (OWNER)
(812) 265-9191
Entity
Organization
Contact information
Practice address
122 DEMAREE DR, MADISON, IN 47250-4622
(812) 265-9191
(812) 265-1050
Mailing address
122 DEMAREE DR, MADISON, IN 47250-4622
(812) 265-9191
(812) 265-1050
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0952312
CLIA FOR MADISON LOCATION
IN
01
—
15D1048313
CLIA FOR COLUMBUS LOCATIO
IN
Enumeration date
11/08/2006
Last updated
03/27/2013
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