NPIMap

Organization Active NPI

Medical and Cosmetic Dermatology, LLC

  • Dermatology Physician
  • Mechanicsburg, PA
National Provider Identifier
1275792582
Registry record updated Sep 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MEDICAL AND COSMETIC DERMATOLOGY, LLC
Practice address
1300 Bent Creek Blvd
Suite 202
Mechanicsburg, PA 17050-1871
Phone
(717) 458-8401
Fax
(717) 458-8403
NPI assigned
Jun 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2008

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

Authorized official

Name
Dr. Serge N Kolev, M.D.NPI 1144205030
Title
Member
Phone
(717) 458-8401

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

1300 Bent Creek Blvd
Suite 202
Mechanicsburg, PA 17050-1871

Mailing address

1300 Bent Creek Blvd
Suite 202
Mechanicsburg, PA 17050-1871
Phone (717) 458-8401

National Provider Directory

National Provider Directory

Locations

1300 Bent Creek Blvd
Ste 202
Mechanicsburg, PA 17050
Phone (717) 458-8401

Practitioners & affiliated clinicians

Practitioners 1

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": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1275792582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 BENT CREEK BLVD",
            "address_2": "SUITE 202",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170501871",
            "telephone_number": "717-458-8401",
            "fax_number": "717-458-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BENT CREEK BLVD",
            "address_2": "SUITE 202",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170501871",
            "telephone_number": "717-458-8401",
            "fax_number": "717-458-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL AND COSMETIC DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "KOLEV",
        "authorized_official_first_name": "SERGE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "717-458-8401",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mechanicsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.