1023018124 NPI number — DERMATOLOGIC CARE INC

Table of content: (NPI 1023018124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023018124 NPI number — DERMATOLOGIC CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMATOLOGIC CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023018124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3424 WILLIAM PENN HWY PENN CENTER EAST
Provider Second Line Business Mailing Address:
BLDG 2 STE 221
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15235-5411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-824-9600
Provider Business Mailing Address Fax Number:
412-824-9614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3424 WILLIAM PENN HWY PENN CENTER EAST
Provider Second Line Business Practice Location Address:
BLDG 2 STE 221
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15235-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-824-9600
Provider Business Practice Location Address Fax Number:
412-824-9614
Provider Enumeration Date:
07/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAWELSKI
Authorized Official First Name:
LISA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
412-824-9600

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  047262L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 770230 . This is a "AETNA VSHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 761358 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".