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General NPI Number Information
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NPI Number | 1750448924
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Entity Type | Organization
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Legal Business Name | BRYN MAWR DERMATOLOGY, P.C.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 775 E LANCASTER AVE STE 200
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City | VILLANOVA
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State | PA
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Zip | 19085-1529
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Country | US
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Telephone | 610-525-7800
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Fax | 610-525-7801
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Provider Business Mailing Address
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Address Line | 775 E LANCASTER AVE STE 200
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City | VILLANOVA
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State | PA
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Zip | 19085-1529
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Country | US
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Telephone | 610-525-7800
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Fax | 610-525-7801
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Authorized Official
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Title or Position | OWNER OF PRACTICE
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Name | DR. CHRISTINE SUSAN STANKO
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Credential | M.D.
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Telephone | 610-525-7800
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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 | MD421785
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License Number State | PA
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