Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD070019L | PA |
N | 207ND0900X | Dermatopathologist | MD070019L | PA |
NPI | 1407856529 |
---|---|
Provider Name | Dennis A Vidmar |
First Address | Cleveland, OH 44106 |
Second Address | Cleveland, OH 44106-2832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 06/05/2021 |