Provider Demographics
NPI:1568602969
Name:DELAWARE VALLEY DERMATOLOGY GROUP LLC
Entity Type:Organization
Organization Name:DELAWARE VALLEY DERMATOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SARUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-478-4350
Mailing Address - Street 1:3411 SILVERSIDE RD
Mailing Address - Street 2:SUITE 107; WEBSTER BUILDING
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4812
Mailing Address - Country:US
Mailing Address - Phone:302-475-4350
Mailing Address - Fax:302-478-4325
Practice Address - Street 1:3411 SILVERSIDE RD
Practice Address - Street 2:SUITE 107; WEBSTER BUILDING
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4812
Practice Address - Country:US
Practice Address - Phone:302-478-8532
Practice Address - Fax:302-478-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty