Avalon Dermatology LLC
NPI 1366208456 · Dermatology Physician · Warren, OH
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Avalon Dermatology LLC is a Dermatology Physician organization in Warren, OH (NPI 1366208456).
Provider details
- NPI number
- 1366208456
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Robert Moosally, Medical Director(330) 609-8814
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- The Grand Resort Dermatology
- Doing business as
- The Grand Resort Dermatology
Registry dates
- Enumerated
- 2024-02-26
- Last updated
- 2024-04-17
- Certified
- 2024-04-17
Frequently asked questions
- What is Avalon Dermatology LLC's NPI number?
- Avalon Dermatology LLC's National Provider Identifier (NPI) is 1366208456, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Avalon Dermatology LLC?
- Avalon Dermatology LLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Avalon Dermatology LLC located?
- Avalon Dermatology LLC's practice location on file with NPPES is 1 American Way Ne, Warren, OH 44484-5531.
- What is Avalon Dermatology LLC's phone number?
- The practice phone number listed in the NPPES registry for Avalon Dermatology LLC is (330) 609-8814.
- Does Avalon Dermatology LLC accept Medicare?
- Avalon Dermatology LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Avalon Dermatology LLC?
- The authorized official listed on Avalon Dermatology LLC's NPPES record is Robert Moosally, Medical Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Avalon Dermatology LLC's NPI active?
- Yes — Avalon Dermatology LLC's NPI (1366208456) is active in the NPPES registry as of the last update on 2024-04-17.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.