Healthcare Provider Details

I. General information

NPI: 1447453170
Provider Name (Legal Business Name): DERMATOLOGY & SKIN SURGERY CENTER OF YORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PINE GROVE CMNS
YORK PA
17403-5161
US

IV. Provider business mailing address

400 PINE GROVE CMNS
YORK PA
17403-5161
US

V. Phone/Fax

Practice location:
  • Phone: 717-755-4422
  • Fax: 717-755-2390
Mailing address:
  • Phone: 717-755-4422
  • Fax: 717-755-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NATALIE IVANA BENE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 717-755-4422