Provider Demographics
NPI:1326238296
Name:DANIEL J LADD DO PA
Entity Type:Organization
Organization Name:DANIEL J LADD DO PA
Other - Org Name:TRU-SKIN DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LADD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:512-451-0139
Mailing Address - Street 1:3500 JEFFERSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6224
Mailing Address - Country:US
Mailing Address - Phone:512-451-0139
Mailing Address - Fax:512-323-5880
Practice Address - Street 1:3500 JEFFERSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6224
Practice Address - Country:US
Practice Address - Phone:512-451-0139
Practice Address - Fax:512-323-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH29480Medicare UPIN
TX00745WMedicare PIN