Provider Demographics
NPI:1942206925
Name:EAST PENN DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:EAST PENN DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:STIERSTORFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-661-0300
Mailing Address - Street 1:311 N SUMNEYTOWN PIKE
Mailing Address - Street 2:STE 1E
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2532
Mailing Address - Country:US
Mailing Address - Phone:215-661-0300
Mailing Address - Fax:215-661-0302
Practice Address - Street 1:311 N SUMNEYTOWN PIKE
Practice Address - Street 2:STE 1E
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2532
Practice Address - Country:US
Practice Address - Phone:215-661-0300
Practice Address - Fax:215-661-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2230853OtherAETNA
PA341275OtherBLUE SHIELD
PA1009001740001Medicaid
PA1009001740001Medicaid