Provider Demographics
NPI:1457333197
Name:PHOENIXVILLE & VALLEY FORGE DERMATOLOGY ASSOCIATES, PC.
Entity Type:Organization
Organization Name:PHOENIXVILLE & VALLEY FORGE DERMATOLOGY ASSOCIATES, PC.
Other - Org Name:DERMATOLOGY ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-983-3980
Mailing Address - Street 1:1260 VALLEY FORGE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-983-3980
Mailing Address - Fax:610-983-3406
Practice Address - Street 1:1260 VALLEY FORGE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-983-3980
Practice Address - Fax:610-983-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X
PA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089339Medicare PIN