Provider Demographics
NPI:1467509810
Name:DERMATOLOGY ASSOCIATES OF WESTERN PENNSYLVANIA INC.
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF WESTERN PENNSYLVANIA INC.
Other - Org Name:DERMATOLOGY ASSOCIATES OF WESTERN PENNSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-262-1064
Mailing Address - Street 1:935 THORN RUN RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2861
Mailing Address - Country:US
Mailing Address - Phone:412-262-1064
Mailing Address - Fax:412-262-3904
Practice Address - Street 1:500 CHERRINGTON PKWY STE 410
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-4749
Practice Address - Country:US
Practice Address - Phone:412-262-1064
Practice Address - Fax:412-262-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027600E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41837Medicare UPIN
PA438695Medicare PIN