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General NPI Number Information
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NPI Number | 1821265943
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Entity Type | Organization
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Legal Business Name | WEST DERMATOLOGY OF PENNSYLVANIA A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 12/08/2008
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Provider Practice Location Address
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Address Line | 150 W BEAU ST SUITE 308
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City | WASHINGTON
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State | PA
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Zip | 15301-4425
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Country | US
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Telephone | 724-225-1505
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Fax | 724-225-5810
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Provider Business Mailing Address
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Address Line | PO BOX 2199
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City | REDLANDS
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State | CA
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Zip | 92373-0721
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Country | US
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Telephone | 909-335-8649
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Fax | 909-557-1953
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN ROBERT WEST
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Credential | M.D.
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Telephone | 909-335-8649
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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 | MD432414
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License Number State | PA
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