Children'S Community Care

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CHILDREN'S COMMUNITY CARE

Practice address

11279 Perry Hwy Ste 108
Wexford, PA 15090-9303

Phone

(724) 933-9190

Fax

(724) 933-9194

NPI assigned

Oct 18, 2006

Organization subpart

No

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

Authorized official

Name

Lori Martinez

Title

Executive Administrator III

Phone

(724) 933-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Children's Dermatology Services Other name

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1619058559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 BRADFORD RD STE 200",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150906910",
            "telephone_number": "724-933-1100",
            "fax_number": "724-933-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11279 PERRY HWY STE 108",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150909303",
            "telephone_number": "724-933-9190",
            "fax_number": "724-933-9194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S COMMUNITY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR III",
        "authorized_official_telephone_number": "724-933-1100"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "001633210",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Dermatology Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Children's Dermatology Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.