Provider Demographics
NPI:1518377092
Name:WILSON DERMATOLOGY & SKIN CARE INC
Entity type:Organization
Organization Name:WILSON DERMATOLOGY & SKIN CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTA
Authorized Official - Middle Name:MICHALEK
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-486-8272
Mailing Address - Street 1:447 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-4300
Mailing Address - Country:US
Mailing Address - Phone:215-486-8272
Mailing Address - Fax:215-757-3600
Practice Address - Street 1:447 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-4300
Practice Address - Country:US
Practice Address - Phone:215-486-8272
Practice Address - Fax:215-757-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093209V4BMedicare PIN