MEDICARE: DERMATOLOGICAL ASSOCIATES PC

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		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	959595	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1043211436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN STE 300
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 LINCOLN WAY
Second Line	:	SUITE 101
City	:	WHITE OAK
State	:	PA
Zip	:	15131
Country	:	US
Telephone Number	:	412-678-8806
Fax Number	:	412-678-3780

Authorized Official
Title or Position	:	DIRECTOR, PROVIDER RELATIONS
Name	:	AMY DECLUE
Credential	:
Telephone Number	:	407-875-2080

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/21/2022

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Directions to “DERMATOLOGICAL ASSOCIATES PC ” Practice Location

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