Organization
AVALON DERMATOLOGY LLC
Active
Organization
AVALON DERMATOLOGY LLC
Active
Other names
The Grand Resort Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT T MOOSALLY DO (MEDICAL DIRECTOR)
(330) 609-8814
Entity
Organization
Contact information
Practice address
1 AMERICAN WAY NE, WARREN, OH 44484-5531
(330) 609-8814
Mailing address
1 AMERICAN WAY NE, WARREN, OH 44484-5531
(330) 609-8814
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
02/26/2024
Last updated
04/17/2024
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