Ohio Skin Cancer Institute LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

OHIO SKIN CANCER INSTITUTE LLC

Practice address

5040 Forest Dr Ste 200
New Albany, OH 43054-8166

Phone

(614) 585-9900

Fax

(614) 585-9999

NPI assigned

Jan 21, 2010

Organization subpart

No

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

Authorized official

Name

Larisa Ravitskiy, MD

Title

Owner

Phone

(614) 585-9900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ohio Dermatology Center Doing business as

Locations

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

{
    "created_epoch": "1264032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1508197112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5040 FOREST DR STE 200",
            "city": "NEW ALBANY",
            "state": "OH",
            "postal_code": "430548166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5040 FOREST DR STE 200",
            "city": "NEW ALBANY",
            "state": "OH",
            "postal_code": "430548166",
            "telephone_number": "614-585-9900",
            "fax_number": "614-585-9999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "602 Morrison Rd",
            "address_purpose": "LOCATION",
            "city": "Gahanna",
            "state": "OH",
            "postal_code": "432305342",
            "country_code": "US",
            "telephone_number": "718-844-8777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OHIO SKIN CANCER INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-21",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "RAVITSKIY",
        "authorized_official_first_name": "LARISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "614-585-9900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2901560",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ohio Dermatology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• MOHS-Micrographic Surgery Physician in New Albany, OH
• Providers in New Albany, OH by specialty
• MOHS-Micrographic Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.