Provider Demographics
NPI:1023382918
Name:PENNSYLVANIA DERMATOLOGY PARTNERS INC
Entity Type:Organization
Organization Name:PENNSYLVANIA DERMATOLOGY PARTNERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-288-2908
Mailing Address - Street 1:258 BEN FRANKLIN HWY E
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-8772
Mailing Address - Country:US
Mailing Address - Phone:610-288-2908
Mailing Address - Fax:610-288-4832
Practice Address - Street 1:2128 PENN AVENUE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1600
Practice Address - Country:US
Practice Address - Phone:610-288-2908
Practice Address - Fax:610-288-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207N00000X, 207ND0101X, 207NP0225X, 207NS0135X, 208200000X, 2086S0122X
207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA238130Medicare PIN
PA412802Medicare PIN