Provider Demographics
NPI:1740201995
Name:PANZER DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:PANZER DERMATOLOGY ASSOCIATES
Other - Org Name:PANZER DERMATOLOGY & COSMETIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KWOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MSMHC
Authorized Official - Phone:302-633-7550
Mailing Address - Street 1:537 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2146
Mailing Address - Country:US
Mailing Address - Phone:302-633-7550
Mailing Address - Fax:302-225-3774
Practice Address - Street 1:537 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 107
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2146
Practice Address - Country:US
Practice Address - Phone:302-633-7550
Practice Address - Fax:302-225-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1989022601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000079402Medicaid
DE000079402Medicaid