Provider Demographics
NPI:1356321558
Name:DERMATOLOGY CLINICS OF WESTMORELAND COUNTY INC
Entity Type:Organization
Organization Name:DERMATOLOGY CLINICS OF WESTMORELAND COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-733-7544
Mailing Address - Street 1:4016 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1823
Mailing Address - Country:US
Mailing Address - Phone:724-733-7544
Mailing Address - Fax:724-325-2935
Practice Address - Street 1:4016 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1823
Practice Address - Country:US
Practice Address - Phone:724-733-7544
Practice Address - Fax:724-325-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016673570001Medicaid
PA1583499OtherBLUE SHIELD
PA0016673570001Medicaid
E55786Medicare UPIN