NPIMap

Organization Active NPI

Dermatology Assoc of Erie

  • Dermatology Physician
  • Erie, PA
National Provider Identifier
1821099623
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY ASSOC OF ERIE
Practice address
3416 State St
Erie, PA 16508-2832
Phone
(814) 456-7548
Fax
(814) 456-5037
NPI assigned
Aug 3, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Donald L Baxter Jr., MDNPI 1174523211
Title
Vice President
Phone
(814) 456-7548

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X PA Primary

Addresses

Primary practice location

3416 State St
Erie, PA 16508-2832

Mailing address

3416 State St
Erie, PA 16508-2832
Phone (814) 456-7548

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050114000389 PA Part B Supplier - Clinic/Group Practice 7719936947 Receives reassigned benefits from 5 practitioners
Practice locations: Erie, PA

National Provider Directory

National Provider Directory

Locations

3416 State St
Erie, PA 16508
Phone (814) 456-7548

Practitioners & affiliated clinicians

Practitioners 8

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": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1821099623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 STATE ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165082832",
            "telephone_number": "814-456-7548",
            "fax_number": "814-456-5037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3416 STATE ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165082832",
            "telephone_number": "814-456-7548",
            "fax_number": "814-456-5037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOC OF ERIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BAXTER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "814-456-7548",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.