NPIMap

Organization Active NPI

Main Line Dermatology, Inc.

  • Specialist
  • Wayne, PA
National Provider Identifier
1497787246
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MAIN LINE DERMATOLOGY, INC.
Practice address
995 Old Eagle School Rd
Suite 304-F
Wayne, PA 19087-1709
Phone
(610) 688-3099
Fax
(610) 687-5350
NPI assigned
Jul 6, 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
Loretta R Kramer
Title
Practice Manager
Phone
(610) 688-3099

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

995 Old Eagle School Rd
Suite 304-F
Wayne, PA 19087-1709

Mailing address

995 Old Eagle School Rd
Suite 304-F
Wayne, PA 19087-1709
Phone (610) 688-3099

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000587 PA Part B Supplier - Clinic/Group Practice 8527051523 Receives reassigned benefits from 12 practitioners
Practice locations: Wayne, PA; West Chester, PA

National Provider Directory

National Provider Directory

Locations

995 Old Eagle School Rd
Ste 30
Wayne, PA 19087

1246 Wrights Ln
West Chester, PA 19380
Phone (610) 696-8615

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497787246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 OLD EAGLE SCHOOL RD",
            "address_2": "SUITE 304-F",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190871709",
            "telephone_number": "610-688-3099",
            "fax_number": "610-687-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "995 OLD EAGLE SCHOOL RD",
            "address_2": "SUITE 304-F",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190871709",
            "telephone_number": "610-688-3099",
            "fax_number": "610-687-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "610-688-3099"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, 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.
  • 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.