Organization
PINE STREET DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEANA COVELLO MD (PRESIDENT)
(215) 574-9101
Entity
Organization
Contact information
Practice address
1233 LOCUST ST., SUITE 101, PHILADELPHIA, PA 19107
(215) 735-2636
(215) 735-2634
Mailing address
1233 LOCUST ST., SUITE 101, PHILADELPHIA, PA 19107
(215) 735-2636
(215) 735-2634
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD067435L
PA
207N00000X
Dermatology Physician
Primary
MD067435L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1458723
HIGHMARK BLUE SHIELD
PA
01
—
2146941000
IBC
PA
01
—
3150557
AETNA
PA
Enumeration date
11/01/2006
Last updated
05/11/2012
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