Healthcare Provider Details

I. General information

NPI: 1396748950
Provider Name (Legal Business Name): DOUGLAS KRESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11279 PERRY HWY STE 108
WEXFORD PA
15090-9303
US

IV. Provider business mailing address

11279 PERRY HWY STE 450
WEXFORD PA
15090-9303
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-9190
  • Fax: 724-933-9194
Mailing address:
  • Phone: 724-933-1100
  • Fax: 724-933-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD057630L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD057630L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: