MEDICARE: READING DERMATOLOGY ASSOCIATES PC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD008407E	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	119570	OTHER	PA	HENDRIX MEDICARE
4	429860	OTHER	PA	BURGET MEDICARE
6	132147	OTHER	PA	MEDICARE SCHLEICHER

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1336317346	OTHER	NPI HENDRIX A
3	1861487449	OTHER	NPI SCHLEICHER
5	1164402475	OTHER	NPI BURGET
7	1407037237	OTHER	NPI HENDRIX J

NPI Number	:	1942442553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	READING DERMATOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	3317 PENN AVE
Second Line	:
City	:	READING
State	:	PA
Zip	:	19609-1436
Country	:	US
Telephone Number	:	107-507-8916
Fax Number	:	610-750-7896

Provider Business Practice Location Address
First Line	:	3317 PENN AVE
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1436
Country	:	US
Telephone Number	:	610-750-7891
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON ERROL HENDRIX
Credential	:	DO
Telephone Number	:	610-750-7891

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	11/23/2020

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308