NPIMap

Organization Active NPI

Aesthetic Dermatology Associates, PC

  • Dermatology Physician
  • Media, PA
National Provider Identifier
1003845835
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
AESTHETIC DERMATOLOGY ASSOCIATES, PC
Practice address
176 S New Middletown Rd Ste 203
Media, PA 19063
Phone
(610) 566-7300
Fax
(610) 891-8973
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jamie F Altman, MDNPI 1932139342
Title
President
Phone
(610) 566-7300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

176 S New Middletown Rd Ste 203
Media, PA 19063

Mailing address

176 S New Middletown Rd Ste 203
Media, PA 19063-5255
Phone (610) 566-7300

Other practice location 1

4 Industrial Blvd Ste 200
Paoli, PA 19301-1605
Phone (610) 647-4161

Other identifiers 15

IdentifierTypeStateIssuer
1587218OtherHIGHMARK
7383842007OtherCIGNA HMO
2269675000OtherKEYSTONE EAST AND 65 ONLY
3473389OtherAET
001587218OtherPERSONAL CHOICE
2269675000OtherAMERIHEALTH HMO
2269675000OtherIBC
P87218OtherAMERIHEALTH BLAIR MILL
001587218OtherAMERIHEALTH
001587218OtherBCBS
3473389OtherAETNA HMO
209076OtherCOVENTRY HMO AND PPO
7383842007OtherCIGNA
7593441OtherAETNA
P00128279OtherMEDICARE RAILROAD

Other names 1

  • Aesthetic Dermatology Associates, PC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040624001174 PA Part B Supplier - Clinic/Group Practice 2466438148 Receives reassigned benefits from 13 practitioners
Practice locations: Media, PA; Paoli, PA
O20241205002383 GA Part B Supplier - Clinic/Group Practice 2466438148 Receives reassigned benefits from 2 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

176 S New Middletown Rd
Ste 203
Media, PA 19063
Phone (610) 566-7300

4 Industrial Blvd
Ste 200SCN
Paoli, PA 19301

21 Industrial Blvd
Ste 203
Paoli, PA 19301
Phone (610) 296-0810

4 Industrial Blvd
Ste 200
Paoli, PA 19301
Phone (610) 644-3166

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1003845835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 S NEW MIDDLETOWN RD STE 203",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635255",
            "telephone_number": "610-566-7300",
            "fax_number": "610-891-8973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 S NEW MIDDLETOWN RD STE 203",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "19063",
            "telephone_number": "610-566-7300",
            "fax_number": "610-891-8973"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Industrial Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Paoli",
            "state": "PA",
            "postal_code": "193011605",
            "country_code": "US",
            "telephone_number": "610-647-4161",
            "fax_number": "610-891-8973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AESTHETIC DERMATOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "ALTMAN",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-566-7300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "1587218",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HMO",
            "identifier": "7383842007",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE EAST AND 65 ONLY",
            "identifier": "2269675000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AET",
            "identifier": "3473389",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "001587218",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH HMO",
            "identifier": "2269675000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC",
            "identifier": "2269675000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH BLAIR MILL",
            "identifier": "P87218",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "001587218",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001587218",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3473389",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HMO AND PPO",
            "identifier": "209076",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7383842007",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7593441",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00128279",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aesthetic Dermatology Associates, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Media, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.