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General NPI Number Information
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NPI Number | 1588131536
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Entity Type | Organization
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Legal Business Name | AESTHETIC DERMATOLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 4 INDUSTRIAL BLVD STE 200
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City | PAOLI
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State | PA
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Zip | 19301-1605
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Country | US
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Telephone | 610-647-4161
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Fax | 610-647-5397
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Provider Business Mailing Address
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Address Line | 176 S NEW MIDDLETOWN RD STE 203
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City | MEDIA
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State | PA
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Zip | 19063-5255
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Country | US
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Telephone | 610-566-7300
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Fax | 610-476-4161
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | GOPAL A PATEL
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Credential | MD
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Telephone | 610-566-7300
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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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