Healthcare Provider Details

I. General information

NPI: 1245386556
Provider Name (Legal Business Name): DERMASURGERY CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HARRISBURG AVE STE 4
LANCASTER PA
17603
US

IV. Provider business mailing address

230 HARRISBURG AVE STE 4
LANCASTER PA
17603
US

V. Phone/Fax

Practice location:
  • Phone: 717-399-9800
  • Fax: 717-399-7613
Mailing address:
  • Phone: 717-399-9800
  • Fax: 717-399-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD430176
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD430176
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD430176
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: SUSAN TERI MCGILLIS
Title or Position: OWNER
Credential:
Phone: 717-399-9800