Organization
BLUE ASH DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIR B PATEL MD (OWNER)
(513) 770-4212
Entity
Organization
Contact information
Practice address
9403 KENWOOD RD, STE B100, BLUE ASH, OH 45242-6895
(513) 891-8045
(513) 891-8110
Mailing address
9403 KENWOOD RD, STE B100, BLUE ASH, OH 45242-6895
(513) 891-8045
(513) 891-8110
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0209139
—
OH
Enumeration date
11/22/2016
Last updated
05/24/2017
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