Healthcare Provider Details

I. General information

NPI: 1790757912
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF LANCASTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 CROOKED OAK DR SUITE 200
LANCASTER PA
17601-4274
US

IV. Provider business mailing address

1650 CROOKED OAK DR SUITE 200
LANCASTER PA
17601-4274
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-3279
  • Fax: 717-569-2187
Mailing address:
  • Phone: 717-569-3279
  • Fax: 717-569-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCIA M GEPHART
Title or Position: EXECUTIVE PRACTICE MANAGER
Credential:
Phone: 717-569-3279