Provider Demographics
NPI:1750666566
Name:LASER SURGERY AND COSMETIC DERMATOLOGY CENTERS INC
Entity Type:Organization
Organization Name:LASER SURGERY AND COSMETIC DERMATOLOGY CENTERS INC
Other - Org Name:MAIN LINE CENTER FOR LASER SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:F
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-645-5551
Mailing Address - Street 1:32 PARKING PLZ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2415
Mailing Address - Country:US
Mailing Address - Phone:610-645-5551
Mailing Address - Fax:610-645-5151
Practice Address - Street 1:32 PARKING PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2415
Practice Address - Country:US
Practice Address - Phone:610-645-5551
Practice Address - Fax:610-645-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045790L207N00000X
PAMD432401207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty