Organization
DERMATOLOGY ASSOC OF CENTRAL PA, PC
Active
Other names
Dermatology Associates of Central PA, PC
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY FORREST MIKESELL M.D. (PRESIDENT)
(814) 238-6097
Entity
Organization
Contact information
Practice address
1393 N ATHERTON ST, STATE COLLEGE, PA 16803-2932
(814) 238-6097
(814) 238-5527
Mailing address
1393 N ATHERTON ST, STATE COLLEGE, PA 16803-2932
(814) 238-6097
(814) 238-5527
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
413750
PA BLUE SHIELD
PA
Enumeration date
10/04/2006
Last updated
03/26/2011
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