Organization
DERMATOLOGY AND SKIN SURGERY CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT L GOTTLIEB M.D. (PRESIDENT)
(610) 594-6660
Entity
Organization
Contact information
Practice address
501 GORDON DR, EXTON, PA 19341-1252
(610) 594-6660
(610) 594-6810
Mailing address
501 GORDON DR, EXTON, PA 19341-1252
(610) 594-6660
(610) 594-6810
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2950305
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100328000
INDEPENDENCE BLUE CROSS
PA
01
—
486908
PENNSYLVANIA BLUE SHIELD
PA
01
—
7758403
AETNA HEALTH PLANS
PA
Enumeration date
05/18/2006
Last updated
09/19/2016
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