Dermatology & Aesthetic Care LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY & AESTHETIC CARE LLC

Practice address

1299 E Alex Bell Rd
Centerville, OH 45459-2658

Phone

(937) 436-1117

Fax

(937) 436-9576

NPI assigned

May 18, 2011

Organization subpart

No

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

Authorized official

Name

Patricia A Dickerson, MD

Title

Owner

Phone

(937) 436-1117

Specialties & licenses 1

Addresses

Other identifiers 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

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

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1962795302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1299 E ALEX BELL RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592658",
            "telephone_number": "937-436-1117",
            "fax_number": "937-436-9576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1299 E ALEX BELL RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592658",
            "telephone_number": "937-436-1117",
            "fax_number": "937-436-9576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & AESTHETIC CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-436-1117",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0055983",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Centerville, OH
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• Dermatology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.