Basic Information
| Provider Information | |||||||||
| NPI: | 1528379823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOLOGY & SKIN CANCER CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 110B | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109731410 | ||||||||
| FaxNumber: | 6109731450 | ||||||||
| Practice Location | |||||||||
| Address1: | 798 HAUSMAN RD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181049108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104320200 | ||||||||
| FaxNumber: | 6104320202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2010 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRADY | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6104320200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | OS004677L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.