NPIMap

Organization Active NPI

Dermatological Associates PC

  • Dermatology Physician
  • White Oak, PA
National Provider Identifier
1043211436
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGICAL ASSOCIATES PC
Practice address
1220 Lincoln Way
Suite 101
White Oak, PA 15131
Phone
(412) 678-8806
Fax
(412) 678-3780
NPI assigned
Aug 9, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Amy Declue
Title
Director, Provider Relations
Phone
(407) 875-2080

Specialties & licenses 1

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

Addresses

Primary practice location

1220 Lincoln Way
Suite 101
White Oak, PA 15131

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172

Other identifiers 2

IdentifierTypeStateIssuer
0006337010001MedicaidPA
959595OtherPAHIGHMARK

National Provider Directory

National Provider Directory

Locations

1220 Lincoln Way
Ste 101
White Oak, PA 15131
Phone (412) 678-8806

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1043211436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 LINCOLN WAY",
            "address_2": "SUITE 101",
            "city": "WHITE OAK",
            "state": "PA",
            "postal_code": "15131",
            "telephone_number": "412-678-8806",
            "fax_number": "412-678-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2022-07-21",
        "certification_date": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER RELATIONS",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006337010001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "959595",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Oak, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.