Organization
KEYSTONE DERMATOLOGY & CENTER FOR SKIN SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY JOHN FULCHIERO JR. M.D., M.S. (OWNER/OPERATOR/PHYSICIAN)
(814) 943-7546
Entity
Organization
Contact information
Practice address
2525 9TH AVE STE 2, ALTOONA, PA 16602-2014
(814) 943-7546
Mailing address
2525 9TH AVE STE 2A, ALTOONA, PA 16602-2014
(814) 943-7546
(814) 943-7544
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD432947
PA
207ND0101X
MOHS-Micrographic Surgery Physician
MD432947
PA
207ND0900X
Dermatopathology Physician
MD432947
PA
207NS0135X
Procedural Dermatology Physician
MD432947
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39D1084575
CLIA
PA
01
—
N/A
N/A
PA
Enumeration date
02/10/2008
Last updated
01/22/2025
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