Provider Demographics
NPI:1801329552
Name:KEYSTONE DERMATOLOGY PARTNERS, LLC
Entity type:Organization
Organization Name:KEYSTONE DERMATOLOGY PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PERLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-356-6942
Mailing Address - Street 1:216 MALL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2923
Mailing Address - Country:US
Mailing Address - Phone:215-390-1449
Mailing Address - Fax:215-390-1449
Practice Address - Street 1:216 MALL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2923
Practice Address - Country:US
Practice Address - Phone:215-390-1449
Practice Address - Fax:215-390-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty