Provider Demographics
NPI:1730267725
Name:ADVANCED DERMATOLOGY AND SKIN SURGERY
Entity type:Organization
Organization Name:ADVANCED DERMATOLOGY AND SKIN SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CARCHIDI
Authorized Official - Last Name:ZAMPOGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-766-0500
Mailing Address - Street 1:950 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4373
Mailing Address - Country:US
Mailing Address - Phone:717-766-0500
Mailing Address - Fax:717-766-0585
Practice Address - Street 1:950 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4373
Practice Address - Country:US
Practice Address - Phone:717-766-0500
Practice Address - Fax:717-766-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418381208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099450U6SMedicare ID - Type Unspecified
PAP55999Medicare UPIN
PADE6062Medicare PIN
PAH69975Medicare UPIN
PAP94712Medicare UPIN
PA099429U6SMedicare ID - Type Unspecified
PA099369Medicare PIN
PA062111U6SMedicare ID - Type Unspecified