Provider Demographics
NPI:1992791305
Name:DERM DX CENTERS FOR DERMATOLOGY, INC.
Entity type:Organization
Organization Name:DERM DX CENTERS FOR DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHLEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-459-0029
Mailing Address - Street 1:20 N LAUREL ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5948
Mailing Address - Country:US
Mailing Address - Phone:570-459-0029
Mailing Address - Fax:570-454-5757
Practice Address - Street 1:20 N LAUREL ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5948
Practice Address - Country:US
Practice Address - Phone:570-459-0029
Practice Address - Fax:570-454-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA347411OtherBLUE SHIELD
PA0017950160001Medicaid
036355Medicare ID - Type Unspecified