Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Dec 21, 2005
License(s)
MD060204L (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 801 YORK ST | Manitowoc, WI 54220-4630 | 920-663-9008 |
| LOCATION | 2001 EHRMAN RD STE 100 | Cranberry Township, PA 16066-2271 | 724-473-0660 |
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.