NPIMap

Organization Active NPI

Riverside Dermatology, LLC

  • Dermatology Physician
  • Laurys Station, PA
National Provider Identifier
1366400236
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
RIVERSIDE DERMATOLOGY, LLC
Practice address
5649 Wynnewood Dr
Suite 202
Laurys Station, PA 18059-1138
Phone
(610) 261-1115
Fax
(610) 261-9601
NPI assigned
May 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Terry Robbins, M.D.NPI 1487647673
Title
Owner
Phone
(610) 261-1115

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 MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

5649 Wynnewood Dr
Suite 202
Laurys Station, PA 18059-1138

Mailing address

5649 Wynnewood Dr
Suite 202
Laurys Station, PA 18059-1138
Phone (610) 261-1115

Other identifiers 5

IdentifierTypeStateIssuer
501504OtherAETNA
02352200OtherPACAPITAL BLUE CROSS
2288874000OtherPERSONAL CHOICE
1611176OtherPAHIGHMARK BLUE SHIELD
P00089866OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

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": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366400236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5649 WYNNEWOOD DR",
            "address_2": "SUITE 202",
            "city": "LAURYS STATION",
            "state": "PA",
            "postal_code": "180591138",
            "telephone_number": "610-261-1115",
            "fax_number": "610-261-9601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5649 WYNNEWOOD DR",
            "address_2": "SUITE 202",
            "city": "LAURYS STATION",
            "state": "PA",
            "postal_code": "180591138",
            "telephone_number": "610-261-1115",
            "fax_number": "610-261-9601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBBINS",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-261-1115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "501504",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02352200",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "2288874000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1611176",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00089866",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurys Station, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.