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General NPI Number Information
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NPI Number | 1518377092
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Entity Type | Organization
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Legal Business Name | WILSON DERMATOLOGY & SKIN CARE INC
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 447 WOODBOURNE RD
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City | LANGHORNE
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State | PA
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Zip | 19047-4300
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Country | US
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Telephone | 215-486-8272
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Fax | 215-757-3600
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Provider Business Mailing Address
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Address Line | 447 WOODBOURNE RD
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City | LANGHORNE
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State | PA
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Zip | 19047-4300
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Country | US
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Telephone | 215-486-8272
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Fax | 215-757-3600
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOROTA MICHALEK WILSON
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Credential | M.D.
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Telephone | 215-486-8272
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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 | MD426076
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License Number State | PA
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