Dermatology of Philadelphia / Mohs Surgery Center, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

DERMATOLOGY OF PHILADELPHIA / MOHS SURGERY CENTER, LLC

Doing business as

Center for Transplant Patients
Dermatology of Philadelphia
Dermatology of Philadelphia / Mohs Surgery Center1 more in Other names

Practice address

200 N 16TH St Ste D
Philadelphia, PA 19102-1225

Phone

(215) 315-3197

NPI assigned

Oct 7, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Mark Abdelmalek, MDNPI 1972543155

Title

Owner

Phone

(215) 990-6788

Specialties & licenses 6

Addresses

Other names 4

• Center for Transplant Patients Doing business as
• Dermatology of Philadelphia Doing business as
• Dermatology of Philadelphia / Mohs Surgery Center Doing business as
• Mohs Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in PA, NJ2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Locations

Practitioners 4

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

• Mark Abdelmalek, M.D.

  • MOHS-Micrographic Surgery Physician
  • Philadelphia, PA
  • NPI 1972543155

  Dermatology, NJ

  Medicare reassignment Care Compare group NPD Authorized official
• Jaryd Freedman, MD

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1528327327

  NJ

  Medicare reassignment Care Compare group NPD
• Shoshana Grossman, M.D.

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1720511074
  Medicare reassignment Care Compare group NPD
• Julianna Nicole Davis, PA-C

  • Medical Physician Assistant
  • Philadelphia, PA
  • NPI 1871000323

  NJ

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613088000000",
    "number": "1932740461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N 16TH ST STE D",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N 16TH ST STE D",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021225",
            "telephone_number": "215-315-3197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY OF PHILADELPHIA / MOHS SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-07",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "ABDELMALEK",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-990-6788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Transplant Patients",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dermatology of Philadelphia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dermatology of Philadelphia / Mohs Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mohs Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mohs Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chris T Derk, MD
• Derkat Medical Supplies Inc.
• Mary Joy Derla
• Corinne Derleth
• Derm Specs of PA PLLC
• Kerry Dermody, CRNP
• Dermscene LLC
• Dermscene LLC
• Jose Dernier Jr.
• Brittany Marie Derocini, CRNA

• MOHS-Micrographic Surgery Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• MOHS-Micrographic Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; 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.