NPIMap

Organization Active NPI

Saginaw Valley Dermatology PC

  • Dermatology Physician
  • Saginaw, MI
National Provider Identifier
1841252855
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
DO049303 Issued in MI
Legal business name
SAGINAW VALLEY DERMATOLOGY PC
Practice address
4705 Towne Centre Rd
Suite 301
Saginaw, MI 48604-2818
Phone
(989) 793-6505
Fax
(989) 793-7411
NPI assigned
Apr 5, 2006
Last updated
May 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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

Authorized official

Name
Dr. David Brian O'Donnell, M.D.NPI 1831152446
Title
President
Phone
(989) 793-6505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X DO049303 MI Primary
MOHS-Micrographic Surgery Physician 207ND0101X DO049303 MI
Dermatopathology Physician 207ND0900X DO049303 MI
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X DO049303 MI
Procedural Dermatology Physician 207NS0135X DO049303 MI

Addresses

Primary practice location

4705 Towne Centre Rd
Suite 301
Saginaw, MI 48604-2818

Mailing address

4705 Towne Centre Rd
Suite 301
Saginaw, MI 48604-2818
Phone (989) 793-6505

Other identifiers 3

IdentifierTypeStateIssuer
103082897MedicaidMI
0707324351OtherMIBLUE CROSS BLUE SHIELD
070006809OtherMIRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

4705 Towne Centre Rd
Ste 3
Saginaw, MI 48604
Phone (989) 793-6505

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1841252855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 TOWNE CENTRE RD",
            "address_2": "SUITE 301",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042818",
            "telephone_number": "989-793-6505",
            "fax_number": "989-793-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 TOWNE CENTRE RD",
            "address_2": "SUITE 301",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042818",
            "telephone_number": "989-793-6505",
            "fax_number": "989-793-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGINAW VALLEY DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "989-793-6505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "DO049303",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MI",
            "license": "DO049303",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "MI",
            "license": "DO049303",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "MI",
            "license": "DO049303",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MI",
            "license": "DO049303",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103082897",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0707324351",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070006809",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.