Dermatology West, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DERMATOLOGY WEST, LLC

Practice address

26410 Center Ridge Rd
Westlake, OH 44145-4067

Phone

(440) 858-3176

NPI assigned

May 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kyle Loren Wagamon, MDNPI 1780758003

Title

Owner

Phone

(440) 858-3176

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle L Wagamon, MD

  • Dermatopathology Physician
  • Warren, OH
  • NPI 1780758003
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053521021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 CASTRO ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941143717",
            "telephone_number": "440-858-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26410 CENTER RIDGE RD",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441454067",
            "telephone_number": "440-858-3176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY WEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGAMON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "LOREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-858-3176",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI",
            "identifier": "1780758003",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurie Christine Demchak
• Nichole Demesmin
• Heidi Lynne Demooy, OT
• Brittany Denney, RBT
• Dental Comfort Care
• Chelsea Des Rosiers, O.D.
• Bryn Michelle Desantis, CNP
• Melanie Rose Desapri, MS,RD,LD
• Sydney Desapri, MED, BCBA, COBA
• Devon Oaks

• Clinic/Center in Westlake, OH
• Providers in Westlake, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.