Provider Demographics
NPI:1962802249
Name:CARLISLE DERMATOLOGY GROUP
Entity type:Organization
Organization Name:CARLISLE DERMATOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:MAP
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-701-8251
Mailing Address - Street 1:19 SPRINT DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7002
Mailing Address - Country:US
Mailing Address - Phone:717-701-8251
Mailing Address - Fax:717-701-8289
Practice Address - Street 1:19 SPRINT DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7002
Practice Address - Country:US
Practice Address - Phone:717-701-8251
Practice Address - Fax:717-701-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-24
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS17070207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty