NPIMap

Organization Active NPI

Family Dermatology of Pennsylvania, PC

  • Dermatology Physician
  • Reading, PA
National Provider Identifier
1669482105
Registry record updated Sep 23, 2014
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OIG exclusion record

The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:

  • BRCH SA exclusion effective May 18, 2016.

Matched on NPI only. Confirm current status with the OIG exclusions search before relying on it.

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FAMILY DERMATOLOGY OF PENNSYLVANIA, PC
Practice address
6 Hearthstone CT
Suite 101
Reading, PA 19606-3065
Phone
(610) 779-7773
Fax
(610) 779-7775
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

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

Authorized official

Name
Dr. Paula M. Nelson, MD
Title
Owner
Phone
(215) 483-3666

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X

Addresses

Primary practice location

6 Hearthstone CT
Suite 101
Reading, PA 19606-3065

Mailing address

629 Beaver Ruin Rd NW
Suite B
Lilburn, GA 30047-3468
Phone (770) 921-4300

Other identifiers 1

IdentifierTypeStateIssuer
102386765-0001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Locations

3516 Silverside Rd
Ste 19
Wilmington, DE 19810
Phone (302) 478-1213

339A Bill France Blvd
Daytona Beach, FL 32114
Phone (386) 253-2070

583 E State Road 434
Longwood, FL 32750
Phone (407) 327-1765

2921 S Orlando Dr
Sanford, FL 32773
Phone (407) 324-0104

1645 Liberty Rd
Ste 201
Sykesville, MD 21784
Phone (410) 549-2107

130 Airport Rd
Hazleton, PA 18202
Phone (570) 454-2435

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

5 Market Pl
Ste 50
New Hope, PA 18938
Phone (215) 862-6000

408 York Rd
Ste A
New Hope, PA 18938
Phone (215) 862-6000

2701 DeKalb Pike
Ste 206
Norristown, PA 19401
Phone (610) 277-5446

9501 Bustleton Ave
Ste 304
Philadelphia, PA 19115

9501 Roosevelt Blvd
Ste 508
Philadelphia, PA 19114
Phone (215) 464-7400

Practitioners & affiliated clinicians

Practitioners 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1669482105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 BEAVER RUIN RD NW",
            "address_2": "SUITE B",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473468",
            "telephone_number": "770-921-4300",
            "fax_number": "770-381-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 HEARTHSTONE CT",
            "address_2": "SUITE 101",
            "city": "READING",
            "state": "PA",
            "postal_code": "196063065",
            "telephone_number": "610-779-7773",
            "fax_number": "610-779-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DERMATOLOGY OF PENNSYLVANIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-483-3666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102386765-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reading, PA

Sources for this page

Verify at the official NPI Registry.