Provider Demographics
NPI:1962886424
Name:THREE RIVERS DERMATOLOGY, LLC
Entity type:Organization
Organization Name:THREE RIVERS DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-262-4911
Mailing Address - Street 1:980 BEAVER GRADE RD
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2774
Mailing Address - Country:US
Mailing Address - Phone:412-262-4911
Mailing Address - Fax:412-262-7856
Practice Address - Street 1:980 BEAVER GRADE RD
Practice Address - Street 2:SUITE 10A
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2774
Practice Address - Country:US
Practice Address - Phone:412-262-4911
Practice Address - Fax:412-262-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453980207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty