Provider Demographics
NPI:1801083159
Name:CHADDS FORD DERMATOLOGY, PC
Entity type:Organization
Organization Name:CHADDS FORD DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:BRITT-KIMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:610-558-1200
Mailing Address - Street 1:6 DICKINSON DR
Mailing Address - Street 2:BLDG 300 STE 311
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9689
Mailing Address - Country:US
Mailing Address - Phone:610-558-1200
Mailing Address - Fax:610-558-7325
Practice Address - Street 1:6 DICKINSON DR
Practice Address - Street 2:BLDG 300 STE 311
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9689
Practice Address - Country:US
Practice Address - Phone:610-558-1200
Practice Address - Fax:610-558-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060818L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0149435000OtherKEYSTONE ID
2167751OtherAETNA ID
PA019696Medicare PIN
019696YS3Medicare PIN
PAG65951Medicare UPIN