Provider Demographics
NPI:1770798233
Name:DERMATOLOGY CENTER,PA
Entity type:Organization
Organization Name:DERMATOLOGY CENTER,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MEYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-254-3118
Mailing Address - Street 1:2021 N MACARTHUR BLVD #300
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2113
Mailing Address - Country:US
Mailing Address - Phone:972-254-3118
Mailing Address - Fax:972-253-7814
Practice Address - Street 1:2015 WESTPARK DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2113
Practice Address - Country:US
Practice Address - Phone:972-254-3118
Practice Address - Fax:972-253-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCP4145Medicare PIN
TX00RM26Medicare PIN