NPIMap

Organization Active NPI

Dermatology Associates of Plymouth Meeting, PC

  • Specialist
  • Plymouth Meeting, PA
National Provider Identifier
1124082862
Registry record updated Apr 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
DERMATOLOGY ASSOCIATES OF PLYMOUTH MEETING, PC
Practice address
531 W Germantown Pike
Suites 200/201
Plymouth Meeting, PA 19462-1325
Phone
(610) 828-0400
Fax
(610) 828-3869
NPI assigned
Apr 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2015

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

Authorized official

Name
Jonathan T Wolfe, MDNPI 1235142084
Title
Owner
Phone
(610) 828-0400

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

531 W Germantown Pike
Suites 200/201
Plymouth Meeting, PA 19462-1325

Mailing address

531 W Germantown Pike
Suites 200/201
Plymouth Meeting, PA 19462-1325
Phone (610) 828-0400

Other identifiers 2

IdentifierTypeStateIssuer
0046672000OtherPAINDEPENDENCE BLUE CROSS
472774OtherPAAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040621000684 PA Part B Supplier - Clinic/Group Practice 6507841970 Receives reassigned benefits from 13 practitioners
Practice locations: Plymouth Meeting, PA; Norristown, PA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0676601Dermatology Assoc Plymouth Meeting PC531 W Germantown Pike Suite 200, Plymouth Meeting, PA 19462ComplianceJan 11, 2027

National Provider Directory

National Provider Directory

Locations

609 W Germantown Pike
Ste 200
Norristown, PA 19403
Phone (610) 828-0400

531 W Germantown Pike
#200201
Plymouth Meeting, PA 19462
Phone (610) 828-0400

531 W Germantown Pike
Fl 2
Plymouth Meeting, PA 19462

531 W Germantown Pike
Plymouth Mtng, PA 19462
Phone (610) 828-0400

531 W Germantown Pike
Ste 200
Plymouth Mtng, PA 19462
Phone (610) 828-0400

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428883200000",
    "number": "1124082862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 W GERMANTOWN PIKE",
            "address_2": "SUITES 200/201",
            "city": "PLYMOUTH MEETING",
            "state": "PA",
            "postal_code": "194621325",
            "telephone_number": "610-828-0400",
            "fax_number": "610-828-3869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 W GERMANTOWN PIKE",
            "address_2": "SUITES 200/201",
            "city": "PLYMOUTH MEETING",
            "state": "PA",
            "postal_code": "194621325",
            "telephone_number": "610-828-0400",
            "fax_number": "610-828-3869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF PLYMOUTH MEETING, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2015-04-13",
        "status": "A",
        "authorized_official_last_name": "WOLFE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-828-0400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "0046672000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "472774",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth Meeting, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.