Organization
ADVANCED DERMATOLOGY OF OHIO, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY E DECLUE (DIRECTOR, PROVIDER SERVICES)
(407) 875-2080
Entity
Organization
Contact information
Practice address
4834 SOCIALVILLE FOSTER RD STE 20, MASON, OH 45040-6827
(513) 459-1988
Mailing address
151 SOUTHHALL LN, STE 300, MAITLAND, FL 32751-7176
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2531406
—
OH
Enumeration date
08/05/2006
Last updated
10/25/2023
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