Dermatology Associates of Ithaca, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

250861 Issued in NY

Legal business name

DERMATOLOGY ASSOCIATES OF ITHACA, LLC

Practice address

1051 Craft Rd
Ithaca, NY 14850-1016

Phone

(607) 257-1107

Fax

(607) 257-0369

NPI assigned

Jan 1, 2011

Organization subpart

No

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

Authorized official

Name

Katie Terrazas

Title

Office Manager

Phone

(607) 257-1107

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

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

• Donna Jo Brigham, FNP

  • Nurse Practitioner
  • Ithaca, NY
  • NPI 1508407180

  NY

  Medicare reassignment Care Compare group NPD
• Theresa Keller, FNP-C

  • Family Nurse Practitioner
  • Ithaca, NY
  • NPI 1447085733

  NY

  Medicare reassignment Care Compare group NPD
• Thomas E Brown, PA

  • Physician Assistant
  • Ithaca, NY
  • NPI 1144323049

  NY

  Medicare reassignment Care Compare group
• Josephine C McAllister, MD

  • Dermatology Physician
  • Ithaca, NY
  • NPI 1679609317

  NY

  Medicare reassignment Care Compare group
• David Allen Mizro, PA

  • Surgical Physician Assistant
  • Auburn, NY
  • NPI 1205882016

  NY

  Medicare reassignment Care Compare group
• Catherine Thompson, PA-C

  • Dermatology Physician
  • Ithaca, NY
  • NPI 1275197964

  NY

  Medicare reassignment Care Compare group
• Mark A Wernham, MS,PA-C

  • Medical Physician Assistant
  • Ithaca, NY
  • NPI 1205849981

  NY

  Medicare reassignment Care Compare group
• Tess Elizabeth Macqueen, PA-C

  • Physician Assistant
  • Ithaca, NY
  • NPI 1861747388

  NY

  Medicare reassignment
• Tonyah Bell, NP

  • Family Nurse Practitioner
  • Ithaca, NY
  • NPI 1770050445
  NPD
• Robert Trail Horn Jr., MD

  • Dermatology Physician
  • Ithaca, NY
  • NPI 1922083641

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1293840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1609170992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 CRAFT RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501016",
            "telephone_number": "607-257-1107",
            "fax_number": "607-257-0369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 CRAFT RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501016",
            "telephone_number": "607-257-1107",
            "fax_number": "607-257-0369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3773 Luker Rd",
            "address_purpose": "LOCATION",
            "city": "Cortland",
            "state": "NY",
            "postal_code": "130459398",
            "country_code": "US",
            "telephone_number": "607-257-1107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF ITHACA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-01",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "TERRAZAS",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "607-257-1107"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "250861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise S. Wittlin-Horvath Psychiatric Nurse Practitioner, PLLC
• Dennis Gould DPM PLLC
• Dental Care With a Difference, PC
• Bernard Francis Depalma, M.ED., PT, ATC
• Andrew M Deriggi, PA
• Adam Derue, RPH
• Ravi Desai, BS PHARMACY
• Allison Desario
• Audrey H Desilva, MD
• Srisatish Devapatla, M.D., FAAP

• Dermatology Physician in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.