Provider Demographics
NPI:1871631291
Name:THE CENTER FOR SKIN SURGERY PC
Entity Type:Organization
Organization Name:THE CENTER FOR SKIN SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HRABOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-940-1005
Mailing Address - Street 1:1606 CARMODY CT
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8568
Mailing Address - Country:US
Mailing Address - Phone:724-940-1005
Mailing Address - Fax:724-940-1006
Practice Address - Street 1:1606 CARMODY CT
Practice Address - Street 2:SUITE 302
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8568
Practice Address - Country:US
Practice Address - Phone:724-940-1005
Practice Address - Fax:724-940-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064345L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA200099OtherUPMC
003462ZC44OtherMEDICARE GROUP MEMBER PROVIDER NUMBER
PA1174522619OtherPROVIDER NPI
PA9856097OtherAETNA
PA0016749600006Medicaid
PA147715OtherMEDICARE PTAN
PA716101OtherHIGHMARK
PA070015781OtherRAILROAD MEDICARE
PA39D0987990OtherCLIA
PA147715OtherMEDICARE PTAN