Healthcare Provider Details

I. General information

NPI: 1023018124
Provider Name (Legal Business Name): DERMATOLOGIC CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 WILLIAM PENN HWY PENN CENTER EAST BLDG 2 STE 221
PITTSBURGH PA
15235-5411
US

IV. Provider business mailing address

3424 WILLIAM PENN HWY PENN CENTER EAST BLDG 2 STE 221
PITTSBURGH PA
15235-5411
US

V. Phone/Fax

Practice location:
  • Phone: 412-824-9600
  • Fax: 412-824-9614
Mailing address:
  • Phone: 412-824-9600
  • Fax: 412-824-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number047262L
License Number StatePA

VIII. Authorized Official

Name: LISA A PAWELSKI
Title or Position: PHYSICIAN
Credential: MD
Phone: 412-824-9600