Provider Demographics
NPI:1841778685
Name:ALTOONA DERMATOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ALTOONA DERMATOLOGY ASSOCIATES LLC
Other - Org Name:ALTOONA DERMATOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:PLUMMER
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-943-9879
Mailing Address - Street 1:1101 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4029
Mailing Address - Country:US
Mailing Address - Phone:814-943-9879
Mailing Address - Fax:814-943-1808
Practice Address - Street 1:1101 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4029
Practice Address - Country:US
Practice Address - Phone:814-943-9879
Practice Address - Fax:814-943-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034860E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty