Organization
DERMATOLOGY CLINIC OF MUNCIE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES WILLIAM BARTHOLOME MD (PRESIDENT)
(765) 288-8188
Entity
Organization
Contact information
Practice address
1808 W ROYALE DR, MUNCIE, IN 47304-2243
(765) 288-8188
(765) 282-7242
Mailing address
1808 W ROYALE DR, MUNCIE, IN 47304-2243
(765) 288-8188
(765) 282-7242
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
50001481A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100105450
—
IN
Enumeration date
10/03/2006
Last updated
10/18/2007
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