Organization
OPTIMA DERMATOLOGY LLC
Active
Organization
OPTIMA DERMATOLOGY LLC
Active
Other names
Advanced Dermatology and Skin Cancer Center LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BERNAT MD (AUTHORIZED OFFICIAL)
(330) 965-8760
Entity
Organization
Contact information
Practice address
987 BOARDMAN CANFIELD RD, BOARDMAN, OH 44512-4222
(330) 965-8760
(330) 965-9325
Mailing address
111 NEW HAMPSHIRE AVE STE 2, PORTSMOUTH, NH 03801-2864
(802) 909-2053
(330) 965-9325
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
Other
Enumeration date
10/13/2005
Last updated
07/01/2024
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