Healthcare Provider Details

I. General information

NPI: 1164909933
Provider Name (Legal Business Name): CDC ALLENTOWN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 HAMILTON BLVD
ALLENTOWN PA
18106-9775
US

IV. Provider business mailing address

1851 SPRINGWOOD RD
BETHLEHEM PA
18015-5092
US

V. Phone/Fax

Practice location:
  • Phone: 215-538-2500
  • Fax:
Mailing address:
  • Phone: 610-838-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD072426L
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID TWARDZIK
Title or Position: EMPLOYEE
Credential: MD
Phone: 610-838-6803