Provider Demographics
NPI:1124082862
Name:DERMATOLOGY ASSOCIATES OF PLYMOUTH MEETING, PC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF PLYMOUTH MEETING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-828-0400
Mailing Address - Street 1:531 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITES 200/201
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1325
Mailing Address - Country:US
Mailing Address - Phone:610-828-0400
Mailing Address - Fax:610-828-3869
Practice Address - Street 1:531 W GERMANTOWN PIKE
Practice Address - Street 2:SUITES 200/201
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1325
Practice Address - Country:US
Practice Address - Phone:610-828-0400
Practice Address - Fax:610-828-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0046672000OtherINDEPENDENCE BLUE CROSS
PA472774OtherAETNA
PA0046672000OtherINDEPENDENCE BLUE CROSS