NPIMap

Organization Active NPI

Dermatology Associates of Lancaster, LTD

  • Dermatology Physician
  • Lancaster, PA
National Provider Identifier
1790757912
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY ASSOCIATES OF LANCASTER, LTD
Practice address
1650 Crooked Oak Dr
Suite 200
Lancaster, PA 17601-4274
Phone
(717) 569-3279
Fax
(717) 569-2187
NPI assigned
Feb 2, 2006
Last updated
Sep 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Authorized official

Name
Marcia M Gephart
Title
Executive Practice Manager
Phone
(717) 569-3279

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

1650 Crooked Oak Dr
Suite 200
Lancaster, PA 17601-4274

Mailing address

1650 Crooked Oak Dr
Suite 200
Lancaster, PA 17601-4274
Phone (717) 569-3279

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000158 PA Part B Supplier - Clinic/Group Practice 1658272307 Receives reassigned benefits from 11 practitioners
Practice locations: Lancaster, PA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0689176Dermatology Associates Lancaster LTD1650 Crooked Oak Drive, Lancaster, PA 17601ComplianceApr 4, 2027

National Provider Directory

National Provider Directory

Locations

1650 Crooked Oak Dr
Ste 200
Lancaster, PA 17601
Phone (717) 569-3279

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1790757912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 CROOKED OAK DR",
            "address_2": "SUITE 200",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176014274",
            "telephone_number": "717-569-3279",
            "fax_number": "717-569-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 CROOKED OAK DR",
            "address_2": "SUITE 200",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176014274",
            "telephone_number": "717-569-3279",
            "fax_number": "717-569-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF LANCASTER, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-02",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "GEPHART",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE PRACTICE MANAGER",
        "authorized_official_telephone_number": "717-569-3279"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; 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.