Commonwealth Dermatology, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD438908 Issued in PA

Legal business name

COMMONWEALTH DERMATOLOGY, P.C.

Practice address

3055 Washington Rd
Suite 203
MC Murray, PA 15317-3279

Phone

(724) 260-5424

Fax

(724) 260-5425

NPI assigned

Apr 4, 2016

Last updated

Jun 6, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Shane Petrie, M.D.NPI 1114128808

Title

President

Phone

(336) 403-5331

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Shane Petrie, M.D.

  • Dermatology Physician
  • McMurray, PA
  • NPI 1114128808
  Medicare reassignment Care Compare group NPD Authorized official
• Brittany Dubois, MPAS, PA-C

  • Physician Assistant
  • Canonsburg, PA
  • NPI 1184114993
  Medicare reassignment Care Compare group
• Jessica Renae Hall, PA-C

  • Dermatology Physician
  • McMurray, PA
  • NPI 1205433505
  Medicare reassignment Care Compare group
• Alexxa Nicole Safko, PA-C

  • Physician Assistant
  • Wexford, PA
  • NPI 1841959681
  Medicare reassignment
• Nikita Raybuck

  • Physician Assistant
  • McMurray, PA
  • NPI 1861291924
  NPD (past)

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1609239847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 WASHINGTON RD",
            "address_2": "SUITE 203",
            "city": "MC MURRAY",
            "state": "PA",
            "postal_code": "153173279",
            "telephone_number": "724-260-5424",
            "fax_number": "724-260-5425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 WASHINGTON RD",
            "address_2": "SUITE 203",
            "city": "MC MURRAY",
            "state": "PA",
            "postal_code": "153173279",
            "telephone_number": "724-260-5424",
            "fax_number": "724-260-5425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-04",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "PETRIE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-403-5331",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD438908",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "PA",
            "license": "MD438908",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103091870-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan H Cohen, DPT
• Samantha Cohen, AUD
• Vered B. Cohen, M.D.
• Sharon Waggett Colaizzi, CRNP
• Stephanie Colodny, M.D.
• Jocelyn Compliment, LPC
• Cynthia Dawn Cooper, MSCCCSLP
• Ryan J Cooper, M.D.
• Alex Perry Corkos, L.M.F.T.
• Douglas James Corkum, MD

• Dermatology Physician in McMurray, PA
• Providers in McMurray, PA by specialty
• Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.