Eastside Dermatology, Inc.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

35054686 Issued in OH

Legal business name

EASTSIDE DERMATOLOGY, INC.

Practice address

150 Taylor Station Rd
Suite 250
Columbus, OH 43213

Phone

(614) 863-3222

Fax

(614) 863-4450

NPI assigned

Jan 17, 2007

Organization subpart

No

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

Authorized official

Name

Alan J Parks, MD

Title

President

Phone

(614) 863-3222

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Eastside Dermatology & Skin Care Center, Eastside Dermatology of Hilla Doing business as

Locations

Practitioners 1

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

• Stephanie L Cotell, M.D.

  • Dermatology Physician
  • Gahanna, OH
  • NPI 1922093459
  NPD

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224115200000",
    "number": "1063564664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 TAYLOR STATION RD",
            "address_2": "SUITE 250",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43213",
            "telephone_number": "614-863-3222",
            "fax_number": "614-863-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 TAYLOR STATION RD",
            "address_2": "SUITE 250",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43213",
            "telephone_number": "614-863-3222",
            "fax_number": "614-863-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2008-10-16",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-863-3222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "OH",
            "license": "35054686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STEPHANIE COTELL ANTHEM I",
            "identifier": "000000214662",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "YAHNA T SMITH CNP NPI",
            "identifier": "1215972484",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALAN PARKS NPI",
            "identifier": "1598751653",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALAN PARKS ANTHEM ID",
            "identifier": "000000118991",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0665856",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STEPHANIE COTELL NPI",
            "identifier": "1922093459",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2285218",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Dermatology & Skin Care Center, Eastside Dermatology of Hilla",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy Eastman
• Easton Healthcare Agency, Inc
• Easton Home Care LLC
• Easton Provider Services
• Chakara Deprece Easton
• Eastside Family Dental
• Eastside Foot & Ankle Center
• Eastside Oxygen and Medical Equipment
• Easy Access Solutions LLC
• Easy Access Solutions LLC

• Procedural Dermatology Physician in Columbus, OH
• Providers in Columbus, OH by specialty
• Procedural Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.