THE GRAND RESORT DERMATOLOGY
NPI 1366208456
Dermatology in Warren, OH

Active since February 26, 2024
1 AMERICAN WAY NE, WARREN, OH 44484(330) 609-8814 Get Directions Write a Review

NPPES record last updated: April 17, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About The Grand Resort Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THE GRAND RESORT DERMATOLOGY (NPI 1366208456) is a healthcare organization registered as a dermatology in Warren, Ohio and active in the NPI registry since February 2024. The organization lists Robert T Moosally, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1366208456
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameAVALON DERMATOLOGY LLC
Location Address1 AMERICAN WAY NEWarren, OH 44484-5531
Mailing Address1 American Way NeWarren, OH 44484-5531 · (330) 609-8814
Organization SubpartNo
Authorized OfficialRobert T MoosallyMedical Director · (330) 609-8814
Enumeration DateFebruary 26, 2024
Last NPPES UpdateApril 17, 2024
NPPES CertifiedApril 17, 2024
✔ NPI 1366208456 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
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.
1 AMERICAN WAY NE, Warren, OH 44484

Other Names 1

Doing Business AsThe Grand Resort Dermatology

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

The Grand Resort Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to The Grand Resort Dermatology, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1437686318
1 AMERICAN WAY NE
Warren, OH 44484
(330) 856-8811
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Avalon Dermatology LLC's NPI number?

The NPI number for Avalon Dermatology LLC is 1366208456. It was assigned to this organization in the NPPES registry on February 26, 2024. The provider is doing business as The Grand Resort Dermatology.

Where is Avalon Dermatology LLC located?

Avalon Dermatology LLC is located at 1 American Way NE, Warren, OH 44484. The listed phone number is (330) 609-8814.

What is Avalon Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Avalon Dermatology LLC enrolled in Medicare?

Yes. Avalon Dermatology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Avalon Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Avalon Dermatology LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Avalon Dermatology LLC was last updated on April 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.