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General NPI Number Information
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NPI Number | 1710131438
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Entity Type | Organization
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Legal Business Name | CHESTER COUNTY DERMATOLOGY
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Dates
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Enumeration Date | 11/07/2008
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 797 E LANCASTER AVE STE 15
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-3315
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Country | US
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Telephone | 610-269-5612
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Fax |
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Provider Business Mailing Address
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Address Line | 797 E LANCASTER AVE STE 15
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-3315
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Country | US
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Telephone | 610-269-5612
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Fax |
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Authorized Official
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Title or Position | OWER
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Name | DANIEL DVORKIN
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Credential | MD
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Telephone | 610-269-5612
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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 | MD010365E
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License Number State | PA
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