Provider Demographics
NPI:1477639425
Name:ASSOCIATES IN MEDICAL AND COSMETIC DERMATOLOGY, PC
Entity Type:Organization
Organization Name:ASSOCIATES IN MEDICAL AND COSMETIC DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-785-3376
Mailing Address - Street 1:500 EVERGREEN DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1032
Mailing Address - Country:US
Mailing Address - Phone:484-785-3376
Mailing Address - Fax:610-358-6913
Practice Address - Street 1:500 EVERGREEN DR
Practice Address - Street 2:SUITE 20
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1032
Practice Address - Country:US
Practice Address - Phone:484-785-3376
Practice Address - Fax:610-358-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA469369OtherAETNA
PA0720544000OtherIBC
PA099183OtherBLUE SHIELD
PA099183Medicare PIN