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General NPI Number Information
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NPI Number | 1275151458
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Entity Type | Organization
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Legal Business Name | SYLVAN DERMATOLOGY LLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 32 PARKING PLZ STE 300
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City | ARDMORE
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State | PA
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Zip | 19003-2443
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Country | US
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Telephone | 202-246-3262
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Fax | 610-200-1411
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Provider Business Mailing Address
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Address Line | 220 GLENN RD
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City | ARDMORE
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State | PA
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Zip | 19003-2512
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Country | US
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Telephone | 202-246-3262
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Fax | 610-200-1411
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Authorized Official
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Title or Position | DIRECTOR
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Name | JON MEYERLE
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Credential | MD
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Telephone | 202-246-3262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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