Provider Demographics
NPI:1245346873
Name:DEHORATIUS, DANIELLE M (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:DEHORATIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3231
Mailing Address - Country:US
Mailing Address - Phone:610-642-1090
Mailing Address - Fax:610-658-5861
Practice Address - Street 1:825 OLD LANCASTER RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3231
Practice Address - Country:US
Practice Address - Phone:610-642-1090
Practice Address - Fax:610-658-5861
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427615207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
103680EGWMedicare PIN
PAI60810Medicare UPIN