Organization Active NPI

Haverford Dermatology PC

  • Dermatology Physician
  • Bryn Mawr, PA
National Provider Identifier
1104065242
Registry record updated Aug 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD067032L Issued in PA
Legal business name
HAVERFORD DERMATOLOGY PC
Practice address
940 E Haverford Rd
Suite 100
Bryn Mawr, PA 19010-3845
Phone
(610) 525-3800
Fax
(610) 525-4700
NPI assigned
Feb 12, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2013

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

Authorized official

Name
Dr. Stacey Turner, M.D.
Title
Physician
Phone
(610) 525-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X MD067032L PA Primary

Addresses

Primary practice location

940 E Haverford Rd
Suite 100
Bryn Mawr, PA 19010-3845

Mailing address

940 E Haverford Rd
Suite 100
Bryn Mawr, PA 19010-3845
Phone (610) 525-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090827000342 PA Part B Supplier - Clinic/Group Practice 0749335784 Receives reassigned benefits from 5 practitioners
Practice locations: Bryn Mawr, PA

National Provider Directory

National Provider Directory

Locations

940 E Haverford Rd
Ste 100
Bryn Mawr, PA 19010
Phone (610) 525-3800

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375315200000",
    "number": "1104065242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 E HAVERFORD RD",
            "address_2": "SUITE 100",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103845",
            "telephone_number": "610-525-3800",
            "fax_number": "610-525-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 E HAVERFORD RD",
            "address_2": "SUITE 100",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103845",
            "telephone_number": "610-525-3800",
            "fax_number": "610-525-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVERFORD DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-12",
        "last_updated": "2013-08-01",
        "status": "A",
        "authorized_official_last_name": "TURNER",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "610-525-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD067032L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryn Mawr, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2013; 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.