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General NPI Number Information
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NPI Number | 1326372137
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Entity Type | Organization
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Legal Business Name | WARTHAN DERMATOLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 12255 UNIVERSITY DR STE 150
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City | FRISCO
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State | TX
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Zip | 75035-9489
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Country | US
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Telephone | 972-542-4646
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Fax | 972-542-0909
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Provider Business Mailing Address
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Address Line | 12255 UNIVERSITY DR STE 150
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City | FRISCO
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State | TX
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Zip | 75035-9489
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Country | US
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Telephone | 972-542-4646
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Fax | 972-542-0909
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Authorized Official
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Title or Position | PROVIDER
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Name | MANDY LYNN WARTHAN
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Credential | MD
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Telephone | 972-542-4646
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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 | L5949
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License Number State | TX
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