NPIMap

Organization Active NPI

Dermdox WB PC

  • Dermatology Physician
  • Wilkes Barre, PA
National Provider Identifier
1497550123
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMDOX WB PC
Practice address
150 Mundy St
Wilkes Barre, PA 18702-6830
Phone
(570) 828-0031
NPI assigned
Feb 17, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

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

Authorized official

Name
Christopher SnyderNPI 1871589259
Title
Owner
Phone
(570) 991-8292

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

150 Mundy St
Wilkes Barre, PA 18702-6830

Mailing address

150 Mundy St
Wilkes Barre, PA 18702-6830
Phone (570) 828-0031

Other practice location 1

1016 W Front St
Berwick, PA 18603-4525
Phone (570) 991-8292

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250401000654 PA Part B Supplier - Clinic/Group Practice 6002339025 Receives reassigned benefits from 6 practitioners
Practice locations: Wilkes Barre, PA

National Provider Directory

National Provider Directory

Locations

2 Brookhill Sq S
Sugarloaf, PA 18249

150 Mundy St
Ste Mac
Wilkes Barre, PA 18702

150 Mundy St
Wilkes Barre Township, PA 18702
Phone (570) 824-0930

Practitioners & affiliated clinicians

Practitioners 12

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": "1739750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743379200000",
    "number": "1497550123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MUNDY ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026830",
            "telephone_number": "570-828-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MUNDY ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026830",
            "telephone_number": "570-828-0031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1016 W Front St",
            "address_purpose": "LOCATION",
            "city": "Berwick",
            "state": "PA",
            "postal_code": "186034525",
            "country_code": "US",
            "telephone_number": "570-991-8292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMDOX WB PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-17",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "SNYDER",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-991-8292"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; 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.