Healthcare Provider Details

I. General information

NPI: 1043211436
Provider Name (Legal Business Name): DERMATOLOGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/21/2022
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 LINCOLN WAY SUITE 101
WHITE OAK PA
15131
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 412-678-8806
  • Fax: 412-678-3780
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMY DECLUE
Title or Position: DIRECTOR, PROVIDER RELATIONS
Credential:
Phone: 407-875-2080