Provider Demographics
NPI:1003845835
Name:AESTHETIC DERMATOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:AESTHETIC DERMATOLOGY ASSOCIATES, PC
Other - Org Name:AESTHETIC DERMATOLOGY ASSOCIATES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-566-7300
Mailing Address - Street 1:176 S NEW MIDDLETOWN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5255
Mailing Address - Country:US
Mailing Address - Phone:610-566-7300
Mailing Address - Fax:610-891-8973
Practice Address - Street 1:176 S NEW MIDDLETOWN RD STE 203
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-566-7300
Practice Address - Fax:610-891-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
001587218OtherPERSONAL CHOICE
3473389OtherAET
P87218OtherAMERIHEALTH BLAIR MILL
001587218OtherAMERIHEALTH
7383842007OtherCIGNA
001587218OtherBCBS
1587218OtherHIGHMARK
7593441OtherAETNA
P00128279OtherMEDICARE RAILROAD
209076OtherCOVENTRY HMO AND PPO
2269675000OtherIBC
3473389OtherAETNA HMO
7383842007OtherCIGNA HMO
2269675000OtherAMERIHEALTH HMO
2269675000OtherKEYSTONE EAST AND 65 ONLY
2269675000OtherKEYSTONE EAST AND 65 ONLY