Organization
LIVE OAK DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ZAYCOSKY DO (OWNER)
(814) 413-7997
Entity
Organization
Contact information
Practice address
7176 W RIDGE RD, FAIRVIEW, PA 16415-2027
(814) 413-7997
(814) 413-7998
Mailing address
7176 W RIDGE RD, FAIRVIEW, PA 16415-2027
(814) 413-7997
(814) 413-7998
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS015047
STATE LIC
PA
Enumeration date
09/21/2023
Last updated
01/30/2025
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