Live Oak Dermatology PC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

LIVE OAK DERMATOLOGY PC

Practice address

7176 W Ridge Rd
Fairview, PA 16415-2027

Phone

(814) 413-7997

Fax

(814) 413-7998

NPI assigned

Sep 21, 2023

Last updated

Jan 30, 2025By 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

Dr. Michael Zaycosky, DONPI 1174789507

Title

Owner

Phone

(814) 413-7997

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Practitioners 4

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.

• Michael Brian Zaycosky, D.O.

  • Dermatology Physician
  • Fairview, PA
  • NPI 1174789507

  Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Kaitlin Troutman

  • Physician Assistant
  • Jamestown, NY
  • NPI 1659117471

  PA

  Medicare reassignment Care Compare group NPD
• Eugene A Snyder Jr., PA

  • Physician Assistant
  • Titusville, PA
  • NPI 1528330545
  Medicare reassignment Care Compare group
• Charity Amelia Snyder, PA-C

  • Medical Physician Assistant
  • Milford, NY
  • NPI 1972933661

  PA

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1609654466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7176 W RIDGE RD",
            "city": "FAIRVIEW",
            "state": "PA",
            "postal_code": "164152027",
            "telephone_number": "814-413-7997",
            "fax_number": "814-413-7998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7176 W RIDGE RD",
            "city": "FAIRVIEW",
            "state": "PA",
            "postal_code": "164152027",
            "telephone_number": "814-413-7997",
            "fax_number": "814-413-7998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 E Plum St",
            "address_purpose": "LOCATION",
            "city": "Edinboro",
            "state": "PA",
            "postal_code": "164122252",
            "country_code": "US",
            "telephone_number": "814-413-7997",
            "fax_number": "814-413-7998",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIVE OAK DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-21",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "ZAYCOSKY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-413-7997",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC",
            "identifier": "OS015047",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• K.D. Andryc DDS and Dental Associates PC
• Amanda Jean Kucic, PTA
• John Dennis Leonard, D.D.S.
• David Ralph Levan, DHSC., OTR/L
• Keith Martin Liccardi, MPT
• Alicia Marie Lyon
• Allison Mailliard
• Susan E Maland, CFOM
• Timothy Gerard Mannino, D.C.
• Renee Charleen Martin, PTA

• MOHS-Micrographic Surgery Physician in Fairview, PA
• Providers in Fairview, PA by specialty
• MOHS-Micrographic Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.