MEDICARE: LEHIGH VALLEY DERMATOLOGY ASSOC LTD

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	207N00000X	PA

General Provider Information

NPI Number	:	1316986763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEHIGH VALLEY DERMATOLOGY ASSOC LTD

Provider Business Mailing Address
First Line	:	190 BRODHEAD RD STE 205
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-8617
Country	:	US
Telephone Number	:	610-866-2010
Fax Number	:	610-866-4359

Provider Business Practice Location Address
First Line	:	190 BRODHEAD RD STE 205
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18017-8617
Country	:	US
Telephone Number	:	610-866-2010
Fax Number	:	610-866-4359

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DAVID B VASILY
Credential	:	MD
Telephone Number	:	610-417-0960

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	09/16/2025

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