Provider Demographics
NPI:1811671092
Name:ALLEGHENY ADVANCED DERMATOLOGY LLC
Entity type:Organization
Organization Name:ALLEGHENY ADVANCED DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KERSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-480-2098
Mailing Address - Street 1:4040 SCOTCH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-5281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 GRANT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4508
Practice Address - Country:US
Practice Address - Phone:814-944-7109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty