1992791156 NPI number — BUCKS-MONT DERMATOLOGY ASSOCIATES PC

Table of content: (NPI 1992791156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992791156 NPI number — BUCKS-MONT DERMATOLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKS-MONT DERMATOLOGY ASSOCIATES PC
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:
6
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:
1992791156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 PROGRESS DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-345-4080
Provider Business Mailing Address Fax Number:
215-345-7575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 PROGRESS DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-345-4080
Provider Business Practice Location Address Fax Number:
215-345-7575
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ADLER
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-345-4080

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  OS003398L , 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: 5256722 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 733753 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001828046 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com