BRAVIA DERMATOLOGY GROUP, LLC (NPI# 1356884837) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356884837 |
| Entity Type | Organization |
| Organization Name | BRAVIA DERMATOLOGY GROUP, LLC |
| Other Organization Name | BRAVIA DERMATOLOGY |
| Practice Address |
2000 Regency Ct Suite #201 Toledo OH 43623-3090 |
| Practice Telephone | 4199483376 |
| Mailing Telephone | 4199483376 |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2018-10-05 |
| Authorized Official Name | MATTHEW A MOLENDA (OWNER) |
| Authorized Official Telephone | 4199483376 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Bravia Dermatology | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1252 Ralston Ave Ste 402, Defiance, OH 435121480 | 4199483376 | 4196653632 |
| 730 N Macomb St Ste 300, Monroe, MI 481622904 | 4199483376 |
| Street Address |
2000 REGENCY CT SUITE #201 |
| City | TOLEDO |
| State | OH |
| Zip Code | 43623-3090 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235132143 | Jonathan D. Wright | Surgery | 2000 Regency Ct, Ste 100, Toledo, OH 43623-3075 | 2005-05-24 |
| 1053706903 | Mercy Health - St. Anne Hospital, LLC | Clinic/Center | 2000 Regency Ct, Suite 101, Toledo, OH 43623-3090 | 2015-03-30 |
| 1013232388 | Thomas Lee Flanigan | Surgery | 2000 Regency Ct, Suite 204, Toledo, OH 43623-3090 | 2010-03-30 |
| 1336338235 | Frank Barone M.d., Inc. | Plastic Surgery | 2000 Regency Ct, Ste 204, Toledo, OH 43623-3090 | 2007-10-17 |
| 1881718310 | Ramon Z. Sevilla, M.d., Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2000 Regency Ct, Suite 200, Toledo, OH 43623-3090 | 2007-03-19 |
| 1265565550 | Regency Urological Associates, Inc. | Specialist | 2000 Regency Ct, Suite 200, Toledo, OH 43623-3090 | 2007-03-14 |
| 1497792683 | Toledo Surgical Specialists, Inc | Surgery | 2000 Regency Ct, Suite 100, Toledo, OH 43623-3090 | 2006-05-31 |
| 1699722090 | Suhail Aftab | Anesthesiology | 2000 Regency Ct, Ste 101, Toledo, OH 43623 | 2006-05-30 |
| 1720035025 | Amy Grant | Specialist | 2000 Regency Ct, #101, Toledo, OH 73623 | 2006-05-30 |
| 1821042045 | Romius Institute of Northwest Ohio, Inc. | Urology | 2000 Regency Ct, Suite #201, Toledo, OH 43623-3090 | 2006-05-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568062750 | Virtual Gender Care Clinic LLC | Clinic/Center | 5616 Birchdale Dr., Toledo, OH 43623 | 2020-10-28 |
| 1043824410 | Paula Milkie | Speech-Language Pathologist | Westwood Early Childhood Center, 3939 Wrenwood, Toledo, OH 43623 | 2020-09-03 |
| 1528678190 | Kori Michelle Pfeiffer | Nurse Practitioner | 4640 Alexis Road, Toledo, OH 43623 | 2020-08-07 |
| 1124683636 | Dana Lynn Oswald | Nurse Practitioner | The Toledo Clinic Cancer Center, 4126 N. Holland Sylvania Rd. Suite 105, Toledo, OH 43623 | 2019-05-09 |
| 1902382922 | Elizabeth Satterthwaite | Dietitian, Registered | 4345 Secor Rd Ste A, Toledo, OH 43623 | 2018-07-12 |
| 1447756804 | Optimum Health Restoration and Anti-aging - Toledo, LLC | General Practice | 4041 Sylvania Avenue, Toledo, OH 43623 | 2018-04-04 |
| 1659897387 | Danajo Marie Woods | Nurse Practitioner | 4235 Secor Rd Bldg 3, Toledo, OH 43623 | 2017-08-15 |
| 1013449784 | Bio-medical Applications of Ohio, Inc. | Clinic/Center | 3546 W. Sylvania Ave, Toledo, OH 43623 | 2017-03-31 |
| 1487101879 | Cletus Payne | Nurse Practitioner | 4405 N. Holland Sylvania Rd., Toledo, OH 43623 | 2016-09-02 |
| 1912451634 | Iman Alazzawi | Registered Nurse | 4615 N Holland Sylvania Rd Apt 40, Toledo, OH 43623 | 2016-08-10 |
| Find all providers in zip 43623 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366860694 | Erin Lowe Heuring | Dermatology | 4204 W Sylvania Ave Ste 100, Toledo, OH 43623 | 2014-04-03 |
| 1720346133 | Krishna A-j Mutgi | Dermatology | 3900 Sunforest Ct Ste 114, Toledo, OH 43623-4440 | 2012-04-24 |
| 1164621579 | Matthew A Molenda | Dermatology | 2000 Regency Ct Ste 201, Toledo, OH 43623-3075 | 2007-07-16 |
| 1366534950 | Thomas K Dillon | Dermatology | 6591 W Central Ave, Ste 105, Toledo, OH 43617-1087 | 2006-09-29 |
| 1235105941 | Mounir Boutros | Dermatology | 5951 Renaissance Pl, Suite C, Toledo, OH 43623-4722 | 2006-02-23 |
| 1326487208 | Nancy Parquet | Dermatology | 3000 Arlington Ave, Toledo, OH 43614-2595 | 2013-06-24 |
| 1952565897 | Matteo C Lopiccolo | Dermatology | 4235 Secor Road, Toledo, OH 43623 | 2008-07-10 |
| 1245322858 | Thomas K Dillon Md, Inc | Dermatology | 6591 W Central Ave, Ste 105, Toledo, OH 43617-1087 | 2006-09-29 |
| 1215968896 | Anders Dermatology Incorporated | Dermatology | 4126 N Holland Sylvania Rd, Suite 200, Toledo, OH 43623-3536 | 2006-07-05 |
| 1811932643 | John Paul Anders | Dermatology | 4126 N Holland Sylvania Rd, Suite 200, Toledo, OH 43623-2504 | 2006-06-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.