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NPI Code Detail

MEDICARE: DELAWARE VALLEY DERMATOLOGY GROUP LLC

MEDICARE: DELAWARE VALLEY DERMATOLOGY GROUP LLC
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
1207ND0101XMOHS-Micrographic Surgery Physician
2207ND0900XDermatopathology Physician
3207NS0135XProcedural Dermatology Physician
4332900000XNon-Pharmacy Dispensing Site
5207N00000XDermatology Physician

General Provider Information

NPI Number : 1568602969
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELAWARE VALLEY DERMATOLOGY GROUP LLC
Provider Business Mailing Address
First Line : 3411 SILVERSIDE RD
Second Line : SUITE 107; WEBSTER BUILDING
City : WILMINGTON
State : DE
Zip : 19810-4812
Country : US
Telephone Number : 302-475-4350
Fax Number : 302-478-4325
Provider Business Practice Location Address
First Line : 3411 SILVERSIDE RD
Second Line : SUITE 107; WEBSTER BUILDING
City : WILMINGTON
State : DE
Zip : 19810-4812
Country : US
Telephone Number : 302-478-8532
Fax Number : 302-478-8536
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DR. MICHAEL L SARUK
Credential : M.D.
Telephone Number : 302-478-4350
Provider Enumeration Date : 02/24/2009
Last Update Date : 06/04/2021

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