Pan Dermatology, PC
Organization Active NPI Dermatopathology Physician · Colonie, NY
NPI 1821164096 · NPPES record last updated Feb 17, 2017
Key facts
- NPI
- 1821164096
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatopathology Physician 207ND0900X
- License
- 239724-1 (NY)
- Legal business name
- PAN DERMATOLOGY, PC
- Practice address
- 105 Everett Rd
Colonie, NY 12205-1407 - Phone
- (518) 694-0999
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Teddy D Pan, MD
- Title
- Principal Owner
- Phone
- (518) 694-0999
Practitioners 4
-
Rachelle Nicholas Gates, P.A.-C
-
Teddy D Pan, MD
-
Kelly Jo Vollmer, PA
-
Megan Kutey, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D1062706 | Pan Dermatology, PC | Compliance | Jul 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070420000155 | NY | Part B Supplier - Clinic/Group Practice | 5698870517 |
Receives reassigned benefits from 4 practitioners Practice locations: Colonie, NY |
National Provider Directory
Locations
400 Patroon Creek Blvd
Ste 105
Albany, NY 12206
Phone (518) 694-0999
105 Everett Rd
Colonie, NY 12205
Phone (518) 453-2206
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology Physician |
207ND0900X | 239724-1 | NY | Yes |
Addresses
Primary practice location
105 Everett Rd
Colonie, NY 12205-1407
Mailing address
105 Everett Rd
Colonie, NY 12205-1407
Phone (518) 694-0999
Other providers in Colonie, NY
- Karen Nellie Montgomery
- Daniel Morales
- Laura Niles
- Jennifer Olszowy
- Golda Osei
- Teddy D Pan
- Physical Therapy Associates of Schenectady, P.C.
- Bethany Pittman
- Matthew Pontbriant
- Preventive Health Nys RN PLLC
All providers in Colonie, NY · Dermatopathology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.