Organization
KENTUCKY DERMATOLOGY CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLEMENS ESCHE M.D. (CEO)
(917) 371-7230
Entity
Organization
Contact information
Practice address
120 STATE AVE, GLASGOW, KY 42141-1451
(917) 371-7230
(636) 444-2042
Mailing address
5480 WISCONSIN AVE, #920, CHEVY CHASE, MD 20815-3530
(917) 371-7230
(636) 444-2042
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
43075
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100106910
—
KY
Enumeration date
03/09/2010
Last updated
06/26/2012
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