Organization
DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIE MASSA M.D. (MANAGING PARTNER)
(859) 263-4444
Entity
Organization
Contact information
Practice address
250 FOUNTAIN CT, LEXINGTON, KY 40509-1888
(859) 263-4444
(859) 543-8867
Mailing address
250 FOUNTAIN CT, LEXINGTON, KY 40509-1888
(859) 263-4444
(859) 543-8867
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
300149
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000304454
ANTHEM BLUE CROSS & BLUE SHIELD
KY
01
—
000000304454
ANTHEM
—
Enumeration date
01/22/2007
Last updated
10/30/2008
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