Provider Demographics
NPI:1831521780
Name:DERMONE DERMATOLOGY ASSOCIATES OF TEXAS PA
Entity type:Organization
Organization Name:DERMONE DERMATOLOGY ASSOCIATES OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP CONTRACTING & PRICING
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-864-5129
Mailing Address - Street 1:200 BARR HARBOR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2979
Mailing Address - Country:US
Mailing Address - Phone:848-240-2812
Mailing Address - Fax:
Practice Address - Street 1:1100 ORCHARD DR STE B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2519
Practice Address - Country:US
Practice Address - Phone:800-337-6663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487951844OtherINDIVIDUAL NPI
1790865970OtherINDIVIDUAL NPI
1962402040OtherINDIVIDUAL NPI
1700932076OtherINDIVIDUAL NPI
1003084914OtherINDIVIDUAL NPI
1710283783OtherINDIVIDUAL NPI
1780734582OtherINDIVIDUAL NPI