Provider Demographics
NPI:1174909527
Name:PEDIATRIC DERMATOLOGY ASSOCIATES OF ERIE LLC
Entity type:Organization
Organization Name:PEDIATRIC DERMATOLOGY ASSOCIATES OF ERIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-456-7548
Mailing Address - Street 1:3405 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2831
Mailing Address - Country:US
Mailing Address - Phone:814-456-7548
Mailing Address - Fax:814-456-5037
Practice Address - Street 1:3405 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2831
Practice Address - Country:US
Practice Address - Phone:814-456-7548
Practice Address - Fax:814-456-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056388L207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty