Healthcare Provider Details

I. General information

NPI: 1801863428
Provider Name (Legal Business Name): RJC FOX CHAPEL DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 FREEPORT RD
ASPINWALL PA
15215-3035
US

IV. Provider business mailing address

241 FREEPORT RD
ASPINWALL PA
15215-3035
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-1606
  • Fax: 412-784-8225
Mailing address:
  • Phone: 412-784-1606
  • Fax: 412-784-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD019308E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. GERRI MOMBERGER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 412-784-8541