Provider Demographics
NPI:1568467652
Name:DERMATOLOGY ASSOCIATES OF LEBANON, LTD
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF LEBANON, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST/DERMATOPATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMSAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KURBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-273-8091
Mailing Address - Street 1:845 NORMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-273-8091
Mailing Address - Fax:707-273-9081
Practice Address - Street 1:845 NORMAN DRIVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-273-8091
Practice Address - Fax:707-273-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014933E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012800160001Medicaid
PA430864OtherMCB/P-TAN
PA=========OtherGROUP TAX ID NUMBER
PA=========OtherGROUP TAX ID NUMBER
PA0430864Medicare ID - Type UnspecifiedMCB GROUP NUMBER
PA0012800160001Medicaid