Provider Demographics
NPI:1811469760
Name:DERMATOLOGY AND MOHS SURGERY CENTER PC
Entity type:Organization
Organization Name:DERMATOLOGY AND MOHS SURGERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREESWINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-345-6647
Mailing Address - Street 1:920 LAWN AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:267-354-1440
Mailing Address - Fax:267-354-1292
Practice Address - Street 1:920 LAWN AVE STE 6
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:267-354-1440
Practice Address - Fax:267-354-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site