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Organization

BRECKSVILLE DERMATOLOGY, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GEORGANN POULOS M.D. (PHYSICIAN/OWNER)
(440) 262-5520
Entity
Organization

Contact information

Practice address
8751 BRECKSVILLE RD STE 50, BRECKSVILLE, OH 44141-1950
(440) 262-5520
Mailing address
8751 BRECKSVILLE RD STE 50, BRECKSVILLE, OH 44141-1950
(440) 262-5520

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35120088
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
35120088
OHIO MEDICAL LICENSE
OH
Enumeration date
01/10/2013
Last updated
01/10/2013
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