Provider Demographics
NPI:1194558601
Name:BRYN MAWR DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:BRYN MAWR DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-525-7800
Mailing Address - Street 1:945 CHESTERBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5614
Mailing Address - Country:US
Mailing Address - Phone:610-525-7800
Mailing Address - Fax:610-525-7801
Practice Address - Street 1:945 CHESTERBROOK BLVD
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5614
Practice Address - Country:US
Practice Address - Phone:610-525-7800
Practice Address - Fax:610-525-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site