Provider Demographics
NPI:1477508257
Name:DERMATOLOGY LTD
Entity Type:Organization
Organization Name:DERMATOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LASKAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-566-7111
Mailing Address - Street 1:101 CHESLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1761
Mailing Address - Country:US
Mailing Address - Phone:610-566-7111
Mailing Address - Fax:610-891-6735
Practice Address - Street 1:101 CHESLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1761
Practice Address - Country:US
Practice Address - Phone:610-566-7111
Practice Address - Fax:610-891-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA827796OtherBLUE SHIELD
PA827796Medicare UPIN