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Organization

KING-MACEYKO DERMATOLOGY ASSOC LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SANDRA H KING (PRACTICE ADMINISTRATOR)
(814) 536-7045
Entity
Organization

Contact information

Practice address
572 PHILADELPHIA ST, INDIANA, PA 15701
(724) 349-7720
(724) 349-8993
Mailing address
350 SOUTHMONT BLVD, JOHNSTOWN, PA 15905-4330
(814) 536-7045
(814) 539-3927

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
723056
BLUE SHIELD
PA
Enumeration date
09/15/2006
Last updated
12/19/2007
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