Provider Demographics
NPI:1336407527
Name:TRUDERM PA
Entity Type:Organization
Organization Name:TRUDERM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-932-5259
Mailing Address - Street 1:3319 STATE ROAD 7
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8092
Mailing Address - Country:US
Mailing Address - Phone:561-207-8080
Mailing Address - Fax:561-207-8082
Practice Address - Street 1:3319 STATE ROAD 7
Practice Address - Street 2:SUITE 202
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8092
Practice Address - Country:US
Practice Address - Phone:561-207-8080
Practice Address - Fax:561-207-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty