Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Jun 8, 2011
License(s)
MT199663 (PA), MD455398 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 1320 BROADCASTING RD SUITE 107 | Wyomissing, PA 19610-3222 | 610-898-8570 |
| LOCATION | 1320 BROADCASTING RD SUITE 107 | Wyomissing, PA 19610-3222 | 610-898-8570 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.