Provider Demographics
NPI:1922747161
Name:NORTH WALES DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:NORTH WALES DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:STIERSTORFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-699-1929
Mailing Address - Street 1:311 N SUMNEYTOWN PIKE STE 1E
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 N SUMNEYTOWN PIKE STE 1E
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2532
Practice Address - Country:US
Practice Address - Phone:215-815-6117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty