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  5. Dermatology Associates, Inc.

Dermatology Associates, Inc.

Company Details

Name: Dermatology Associates, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Revoked Entity
Date of Organization in Rhode Island: 18 Oct 2012 (12 years ago)
Date of Dissolution: 18 Oct 2019 (5 years ago)
Date of Status Change: 18 Oct 2019 (5 years ago)
Identification Number: 000793936
ZIP code: 02818
County: Kent County
Principal Address: 1351 SOUTH COUNTY TRAIL #3 SUITE 302, EAST GREENWICH, RI, 02818, USA
Purpose: THE PRACTICE OF DERMATOLOGY
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1649515313 2012-12-06 2012-12-20 1351 S COUNTY TRL, SUITE 302, EAST GREENWICH, RI, 028185105, US 1351 S COUNTY TRL, SUITE 302, EAST GREENWICH, RI, 028185105, US

Contacts
Phone +1 401-471-6405
Fax 4016322842

Authorized person
Name DR. ANITA E PEDVIS-LEFTICK
Role OWNER
Phone 4014716405

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number 10175
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CREATED FROM DERMATOLOGY ASSOCIATES, INC. DEFINED BENEFIT PENSION PLAN 2016 461221226 2017-09-28 DERMATOLOGY ASSOCIATES, INC. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818
DERMATOLOGY ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2016 461221226 2017-09-28 DERMATOLOGY ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818
DERMATOLOGY ASSOCIATES, INC. DEFINED BENEFIT PENSION PLAN 2016 461221226 2017-06-14 DERMATOLOGY ASSOCIATES, INC. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818
DERMATOLOGY ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2016 461221226 2017-02-22 DERMATOLOGY ASSOCIATES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818
DERMATOLOGY ASSOCIATES, INC. DEFINED BENEFIT PENSION PLAN 2015 461221226 2016-06-24 DERMATOLOGY ASSOCIATES, INC. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818
DERMATOLOGY ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2015 461221226 2016-06-24 DERMATOLOGY ASSOCIATES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818
DERMATOLOGY ASSOCIATES, INC. DEFINED BENEFIT PENSION PLAN 2014 461221226 2015-09-16 DERMATOLOGY ASSOCIATES, INC. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818

Signature of
Role Plan administrator
Date 2015-09-16
Name of individual signing ANITA PEDVIS-LEFTICK
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2014 461221226 2015-09-22 DERMATOLOGY ASSOCIATES, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818

Signature of
Role Plan administrator
Date 2015-09-22
Name of individual signing ANITA PEDVIS-LEFTICK
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY ASSOCIATES, INC. DEFINED BENEFIT PENSION PLAN 2013 461221226 2014-09-15 DERMATOLOGY ASSOCIATES, INC. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818

Signature of
Role Plan administrator
Date 2014-09-15
Name of individual signing ANITA PEDVIS-LEFTICK
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN 2013 461221226 2014-05-16 DERMATOLOGY ASSOCIATES, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-02-15
Business code 621111
Sponsor’s telephone number 4018865663
Plan sponsor’s address 1351 SOUTH COUNTY TRAIL, SUITE 302, EAST GREENWICH, RI, 02818

Signature of
Role Plan administrator
Date 2014-05-16
Name of individual signing ANITA PEDVIS-LEFTICK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SHEILA M. COOLEY, ESQ. Agent 178 DIVISION STREET, EAST GREENWICH, RI, 02818, USA

PRESIDENT

Name Role Address
MATT L. LEAVITT USA PRESIDENT 1351 SOUTH COUNTY TRAIL, BLDG3, SUITE 302 EAST GREENWICH, RI 02818 USA

TREASURER

Name Role Address
MATT L. LEAVITT TREASURER 1351 SOUTH COUNTY TRAIL, BLDG3, SUITE 302 EAST GREENWICH, RI 02818 USA

SECRETARY

Name Role Address
MATT L. LEAVITT SECRETARY 1351 SOUTH COUNTY TRAIL, BLDG3, SUITE 302 EAST GREENWICH, RI 02818 USA

DIRECTOR

Name Role Address
MATT L. LEAVITT DIRECTOR 1351 SOUTH COUNTY TRAIL, BLDG3, SUITE 302 EAST GREENWICH, RI 02818 USA

Filings

Number Name File Date
201924622060 Revocation Certificate For Failure to File the Annual Report for the Year 2019-10-18
201907123380 Revocation Notice For Failure to File An Annual Report 2019-07-24
201858106900 Annual Report - Amended 2018-02-12
201856310020 Annual Report 2018-01-18
201731173500 Annual Report 2017-01-30
201692654470 Annual Report 2016-02-18
201554234790 Annual Report 2015-01-26
201436131120 Annual Report 2014-02-24
201311125680 Annual Report 2013-02-06
201299617030 Articles of Incorporation 2012-10-18

Related by officers

SHEILA M. COOLEY, ESQ.

ELIZABETH INDUSTRIES INC. ONE DAY, LLC

Related by address

1351 SOUTH COUNTY TRAIL #3 SUITE 302, EAST GREENWICH, RI, 02818, USA

RI Rheumatology, Inc.

Date of last update: 17 Oct 2024

Sources: Rhode Island Department of State

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