Provider Demographics
NPI:1710131438
Name:CHESTER COUNTY DERMATOLOGY
Entity Type:Organization
Organization Name:CHESTER COUNTY DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-269-5612
Mailing Address - Street 1:797 E LANCASTER AVE
Mailing Address - Street 2:STE 15
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3315
Mailing Address - Country:US
Mailing Address - Phone:610-269-5612
Mailing Address - Fax:
Practice Address - Street 1:797 E LANCASTER AVE
Practice Address - Street 2:STE 15
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3315
Practice Address - Country:US
Practice Address - Phone:610-269-5612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010365E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
082894OtherASSOCIATED WITH
082894OtherASSOCIATED WITH