Organization
KING-MACEYKO DERMATOLOGY ASSOC LTD
Active
Parent organization
KING-MACEYKO DERMATOLOGY ASSOC LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
KING-MACEYKO DERMATOLOGY ASSOC LTD
Authorized official
SANDRA H KING (PRACTICE ADMINISTRATOR)
(814) 536-7045
Entity
Organization
Contact information
Practice address
223 S PLEASANT AVE, SUITE 101, SOMERSET, PA 15501
(814) 443-6918
(814) 539-3927
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
—
721126
BLUE SHIELD MEDICARE GROUP NUMBER
PA
Enumeration date
06/20/2008
Last updated
06/20/2008
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