MEDICARE: EAST PENN DERMATOLOGY, P.C.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2230853	OTHER	PA	AETNA
2	341275	OTHER	PA	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942206925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST PENN DERMATOLOGY, P.C.

Provider Business Mailing Address
First Line	:	311 N SUMNEYTOWN PIKE
Second Line	:	STE 1E
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2532
Country	:	US
Telephone Number	:	215-661-0300
Fax Number	:	215-661-0302

Provider Business Practice Location Address
First Line	:	311 N SUMNEYTOWN PIKE
Second Line	:	STE 1E
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2532
Country	:	US
Telephone Number	:	215-661-0300
Fax Number	:	215-661-0302

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL B STIERSTORFER
Credential	:	M.D.
Telephone Number	:	215-661-0300

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	11/22/2022

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