Provider Demographics
NPI:1497787246
Name:MAIN LINE DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:MAIN LINE DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-688-3099
Mailing Address - Street 1:995 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:SUITE 304-F
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1709
Mailing Address - Country:US
Mailing Address - Phone:610-688-3099
Mailing Address - Fax:610-687-5350
Practice Address - Street 1:995 OLD EAGLE SCHOOL RD
Practice Address - Street 2:SUITE 304-F
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1709
Practice Address - Country:US
Practice Address - Phone:610-688-3099
Practice Address - Fax:610-687-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty