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INTEGRATED DERMATOLOGY OF GRANVILLE, LLC
NPI 1609204908
Dermatology in Granville, OH

Active since October 23, 2013CLIA 36D0997300 · Certificate of Compliance
1959 NEWARK GRANVILLE RD, GRANVILLE, OH 43023(740) 587-0778(740) 587-0601 Get Directions Write a Review

NPPES record last updated: January 18, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Integrated Dermatology Of Granville, Llc NPPES

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

INTEGRATED DERMATOLOGY OF GRANVILLE, LLC (NPI 1609204908) is a healthcare organization registered as a dermatology in Granville, Ohio and active in the NPI registry since October 2013. The organization holds a CLIA Certificate of Compliance certificate valid through May 7, 2028 and lists Jeffrey D. Queen, Owner, as its authorized official.

NPPES Registry Identity

NPI1609204908
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameINTEGRATED DERMATOLOGY OF GRANVILLE, LLC
Location Address1959 NEWARK GRANVILLE RDGranville, OH 43023-9171
Mailing Address4700 Exchange Ct Ste 110Boca Raton, FL 33431-4450 · (561) 314-2000 · Fax (561) 314-2000
Phone(740) 587-0778
Fax(740) 587-0601
Organization SubpartNo
Authorized OfficialJeffrey D. QueenOwner · (561) 314-2000
Enumeration DateOctober 23, 2013
Last NPPES UpdateJanuary 18, 2019
✔ NPI 1609204908 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.
1959 NEWARK GRANVILLE RD, Granville, OH 43023
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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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 36D0997300

Integrated Dermatology Of Granville · Granville, OH
Active · expires May 7, 2028
CLIA Number36D0997300
Laboratory TypePhysician Office
Certificate Effective DateMay 8, 2026
Certificate Expiration DateMay 7, 2028
Laboratory DirectorDr. Melinda Woofter
Laboratory Phone(740) 587-0778
Laboratory LocationIntegrated Dermatology Of Granville1959 Newark-Granville Rd, Granville, OH 43023
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MIDWEST DERMATOLOGY CENTRE LLC
Dermatology
1959 NEWARK GRANVILLE RD
GRANVILLE, OH 43023
Licking County (740) 587-0778

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 Integrated Dermatology Of Granville, LLC's NPI number?

The NPI number for Integrated Dermatology Of Granville, LLC is 1609204908. It was assigned to this organization in the NPPES registry on October 23, 2013.

Where is Integrated Dermatology Of Granville, LLC located?

Integrated Dermatology Of Granville, LLC is located at 1959 Newark Granville Rd, Granville, OH 43023. The listed phone number is (740) 587-0778.

What is Integrated Dermatology Of Granville, LLC's specialty?

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

Does Integrated Dermatology Of Granville, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 36D0997300) is associated with this NPI, valid through May 7, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Integrated Dermatology Of Granville, LLC was last updated on January 18, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.