MEDICARE: DERMATOLOGIC CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	047262L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	770230	OTHER	PA	AETNA VSHC
2	761358	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1023018124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGIC CARE INC

Provider Business Mailing Address
First Line	:	3424 WILLIAM PENN HWY PENN CENTER EAST
Second Line	:	BLDG 2 STE 221
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5411
Country	:	US
Telephone Number	:	412-824-9600
Fax Number	:	412-824-9614

Provider Business Practice Location Address
First Line	:	3424 WILLIAM PENN HWY PENN CENTER EAST
Second Line	:	BLDG 2 STE 221
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-5411
Country	:	US
Telephone Number	:	412-824-9600
Fax Number	:	412-824-9614

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	LISA A PAWELSKI
Credential	:	MD
Telephone Number	:	412-824-9600

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/22/2020

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Directions to “DERMATOLOGIC CARE INC ” Practice Location

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