MEDICARE: NORTH WALES DERMATOLOGY, PLLC

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

General Provider Information

NPI Number	:	1922747161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH WALES DERMATOLOGY, PLLC

Provider Business Mailing Address
First Line	:	311 N SUMNEYTOWN PIKE STE 1E
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 N SUMNEYTOWN PIKE STE 1E
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2532
Country	:	US
Telephone Number	:	415-802-1310
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. MICHAEL BROOKS STIERSTORFER
Credential	:	MD
Telephone Number	:	215-699-1929

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	09/25/2025

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