Provider Demographics
NPI:1255818522
Name:DELMARVA SKIN PA
Entity type:Organization
Organization Name:DELMARVA SKIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGHADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-564-0001
Mailing Address - Street 1:38394 DUPONT BLVD UNIT F&G
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3049
Mailing Address - Country:US
Mailing Address - Phone:302-564-0001
Mailing Address - Fax:
Practice Address - Street 1:38394 DUPONT BLVD UNIT FG
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-3049
Practice Address - Country:US
Practice Address - Phone:302-564-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0011369207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty