Mansfield Dermatology Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

35054857M Issued in OH

Legal business name

MANSFIELD DERMATOLOGY INC

Practice address

161 Cline Avenue
Mansfield, OH 44907

Phone

(419) 756-5739

Fax

(419) 756-4968

NPI assigned

Oct 2, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Deborah Lynne Moritz, MDNPI 1518063056

Title

Owner

Phone

(419) 756-5739

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, and the practitioner matching its NPPES authorized official.

• Deborah Lynne Moritz, MD

  • Dermatology Physician
  • Mansfield, OH
  • NPI 1518063056
  Authorized official Same address or phone

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316030521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 543",
            "city": "LEWIS CENTER",
            "state": "OH",
            "postal_code": "43035",
            "telephone_number": "740-549-2596",
            "fax_number": "740-549-0047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 CLINE AVENUE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "44907",
            "telephone_number": "419-756-5739",
            "fax_number": "419-756-4968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANSFIELD DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MORITZ",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-756-5739",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35054857M",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0856720",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Dermatology Physician 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.