Provider Demographics
NPI:1447327689
Name:METROPOLITAN DERMATOLOGY ASSOC INC
Entity type:Organization
Organization Name:METROPOLITAN DERMATOLOGY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-687-1492
Mailing Address - Street 1:2475 E 22ND STREET
Mailing Address - Street 2:#210
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115
Mailing Address - Country:US
Mailing Address - Phone:216-687-1492
Mailing Address - Fax:216-687-1499
Practice Address - Street 1:2475 E 22ND STREET
Practice Address - Street 2:#210
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-687-1492
Practice Address - Fax:216-687-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9174121Medicare ID - Type Unspecified