Provider Demographics
NPI:1750448924
Name:BRYN MAWR DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:BRYN MAWR DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:STANKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-525-7800
Mailing Address - Street 1:775 E LANCASTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1529
Mailing Address - Country:US
Mailing Address - Phone:610-525-7800
Mailing Address - Fax:610-525-7801
Practice Address - Street 1:775 E LANCASTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1529
Practice Address - Country:US
Practice Address - Phone:610-525-7800
Practice Address - Fax:610-525-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421785207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty