Healthcare Provider Details

I. General information

NPI: 1750666566
Provider Name (Legal Business Name): LASER SURGERY AND COSMETIC DERMATOLOGY CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 PARKING PLZ SUITE 200
ARDMORE PA
19003-2415
US

IV. Provider business mailing address

32 PARKING PLZ SUITE 200
ARDMORE PA
19003-2415
US

V. Phone/Fax

Practice location:
  • Phone: 610-645-5551
  • Fax: 610-645-5151
Mailing address:
  • Phone: 610-645-5551
  • Fax: 610-645-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD045790L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD432401
License Number StatePA

VIII. Authorized Official

Name: DR. ERIC F. BERNSTEIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 610-645-5551