Edgebrook Dermatology, PC.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

EDGEBROOK DERMATOLOGY, PC.

Practice address

1639 N Alpine Rd
Rockford, IL 61107-1449

Phone

(815) 229-9333

NPI assigned

Dec 14, 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

Maria AlbashaNPI 1922199967

Title

President

Phone

(815) 229-9333

Specialties & licenses 1

Addresses

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.

• Maria I Al-Basha, MD

  • Dermatology Physician
  • Rockford, IL
  • NPI 1922199967
  NPD (past) Authorized official

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710049234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1686",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611100186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071449",
            "telephone_number": "815-229-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEBROOK DERMATOLOGY, PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALBASHA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-229-9333"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney R Eckhoff, APRN
• Jithinraj Edakkanambeth Varayil, MD
• Kathryn Ashley Edgcomb, D.D.S., M.S.
• Leslie Paul Edgcomb, M.D.
• Edgebrook Dermatology P.C.
• Edgebrook Physical Therapy, Inc. (CORA Physical Therapy - Edgebrook)
• Emma Edgell, PTA
• Celestina Edleman
• William C. Edleman, LCSW
• Edward P. Rentschler DDS, PC (Rockford OMS)

• Dermatology Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Dermatology Physician in Illinois

• 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.