Provider Demographics
NPI:1144213547
Name:DERMATOLOGY & COSMETIC SURGERY CENTER PC
Entity Type:Organization
Organization Name:DERMATOLOGY & COSMETIC SURGERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:M
Authorized Official - Last Name:VUJEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-429-2570
Mailing Address - Street 1:100 N WREN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1248
Mailing Address - Country:US
Mailing Address - Phone:412-429-2570
Mailing Address - Fax:412-429-2572
Practice Address - Street 1:100 N WREN DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1248
Practice Address - Country:US
Practice Address - Phone:412-429-2570
Practice Address - Fax:412-429-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10721500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0077311140002Medicaid
PA2678747OtherAETNA US HEALTHCARE
PA1265OtherBLUE CROSS
PA1540531OtherUMWA
PA301440OtherUPMC
PA0077311140002Medicaid
PA2678747OtherAETNA US HEALTHCARE