Provider Demographics
NPI:1467649939
Name:CENTER FOR DERMATOLOGY, PA
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZABEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:952-469-5033
Mailing Address - Street 1:20520 KEOKUK AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6083
Mailing Address - Country:US
Mailing Address - Phone:952-469-5033
Mailing Address - Fax:952-469-5069
Practice Address - Street 1:20520 KEOKUK AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6083
Practice Address - Country:US
Practice Address - Phone:952-469-5033
Practice Address - Fax:952-469-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04238Medicare PIN