Provider Demographics
NPI:1790757912
Name:DERMATOLOGY ASSOCIATES OF LANCASTER, LTD
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF LANCASTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-569-3279
Mailing Address - Street 1:1650 CROOKED OAK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4274
Mailing Address - Country:US
Mailing Address - Phone:717-569-3279
Mailing Address - Fax:717-569-2187
Practice Address - Street 1:1650 CROOKED OAK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4274
Practice Address - Country:US
Practice Address - Phone:717-569-3279
Practice Address - Fax:717-569-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000759Medicare ID - Type UnspecifiedGROUP ID