Organization
PENNSYLVANIA DERMATOLOGY GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL CHACHKIN MD424579 (MD)
(215) 947-7500
Entity
Organization
Contact information
Practice address
2301 HUNTINGDON PIKE, SUITE 202, HUNTINGDON VALLEY, PA 19006-6130
(215) 947-7500
(215) 947-7501
Mailing address
2301 HUNTINGDON PIKE, SUITE 202, HUNTINGDON VALLEY, PA 19006-6130
(215) 947-7500
(215) 947-7501
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0073470000
KEYSTONE
PA
01
—
123121
AETNA INDIVIDUAL #
PA
01
—
1578646899
INDIVIDUAL NPI
PA
01
—
969482
AETNA GROUP #
PA
Enumeration date
01/05/2007
Last updated
10/22/2019
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