Provider Demographics
NPI:1821160011
Name:DERMATOLOGY ASSOCIATES OF DELAWARE VALLEY PC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF DELAWARE VALLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:COCH BENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-325-5553
Mailing Address - Street 1:3501 W CHESTER PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3708
Mailing Address - Country:US
Mailing Address - Phone:610-325-5553
Mailing Address - Fax:610-325-5532
Practice Address - Street 1:3501 W CHESTER PIKE
Practice Address - Street 2:UNIT 205
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3704
Practice Address - Country:US
Practice Address - Phone:610-325-5553
Practice Address - Fax:610-325-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD07523L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD070523LOtherMEDICAL LICENSE