Provider Demographics
NPI:1154151439
Name:DERMATOLOGIST OF LANCASTER LLC
Entity type:Organization
Organization Name:DERMATOLOGIST OF LANCASTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-947-4148
Mailing Address - Street 1:1613 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4335
Mailing Address - Country:US
Mailing Address - Phone:717-947-4148
Mailing Address - Fax:717-947-7958
Practice Address - Street 1:1613 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4335
Practice Address - Country:US
Practice Address - Phone:717-947-4148
Practice Address - Fax:717-947-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty