Organization
CHILDREN'S COMMUNITY CARE
Active
Other names
Children's Dermatology Services
Organization subpart
No
Provider details
NPI number
Authorized official
LORI MARTINEZ (EXECUTIVE ADMINISTRATOR III)
(724) 933-1100
Entity
Organization
Contact information
Practice address
11279 PERRY HWY STE 108, WEXFORD, PA 15090-9303
(724) 933-9190
(724) 933-9194
Mailing address
103 BRADFORD RD STE 200, WEXFORD, PA 15090-6910
(724) 933-1100
(724) 933-1160
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001633210
HIGHMARK
PA
Enumeration date
10/18/2006
Last updated
09/13/2023
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