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General NPI Number Information
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NPI Number | 1104094655
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Entity Type | Organization
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Legal Business Name | EASTON DERMATOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 403 MARVEL CT
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City | EASTON
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State | MD
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Zip | 21601-4053
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Country | US
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Telephone | 410-819-8867
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Fax | 410-822-0416
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Provider Business Mailing Address
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Address Line | 403 MARVEL CT
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City | EASTON
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State | MD
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Zip | 21601-4053
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Country | US
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Telephone | 410-819-8867
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Fax | 410-822-0416
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL A DEL TORTO
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Credential | M.D.
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Telephone | 410-819-8867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0059921
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License Number State | MD
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