DERMATOLOGY SPECIALISTS OF PENNSYLVANIA
NPI 1790395747
Dermatology in Southampton, PA

Active since August 05, 2020
1122 STREET RD STE 204, SOUTHAMPTON, PA 18966(415) 802-1310(415) 579-3505 Get Directions Write a Review

NPPES record last updated: August 5, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dermatology Specialists Of Pennsylvania NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY SPECIALISTS OF PENNSYLVANIA (NPI 1790395747) is a healthcare organization registered as a dermatology in Southampton, Pennsylvania and active in the NPI registry since August 2020. The organization lists Roman Bronfenbrener, Owner, as its authorized official.

NPPES Registry Identity

NPI1790395747
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameDERMATOLOGY SPECIALISTS OF PENNSYLVANIA
Location Address1122 STREET RD STE 204Southampton, PA 18966-4218
Mailing Address1122 Street Rd Ste 204Southampton, PA 18966-4218 · (415) 802-1310 · Fax (415) 579-3505
Fax(415) 579-3505
Organization SubpartNo
Authorized OfficialRoman BronfenbrenerOwner · (415) 802-1310
Enumeration DateAugust 5, 2020
NPPES CertifiedAugust 5, 2020
✔ NPI 1790395747 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
1122 STREET RD STE 204, Southampton, PA 18966

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dermatology Specialists Of Pennsylvania is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Dermatology Specialists Of Pennsylvania, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Micrographic Dermatologic Surgery (MDS)
NPI 1134488638
1122 STREET RD STE 204
Southampton, PA 18966
(215) 999-7546
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1740793215
1122 STREET RD STE 2044218
Southampton, PA 18966
(215) 999-7546
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1851928568
3400 CIVIC CENTER BLVD 1-330S PERELMAN CENTER
Philadelphia, PA 19104
(215) 662-2737
✔ PECOS✔ Accepts Medicare28 mi
Dermatology
NPI 1548898372
3400 CIVIC CENTER BLVD 1-330S PERELMAN CENTER
Philadelphia, PA 19104
(215) 662-2737
✔ PECOS✔ Accepts Medicare28 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatology Specialists Of Pennsylvania's NPI number?

The NPI number for Dermatology Specialists Of Pennsylvania is 1790395747. It was assigned to this organization in the NPPES registry on August 5, 2020.

Where is Dermatology Specialists Of Pennsylvania located?

Dermatology Specialists Of Pennsylvania is located at 1122 Street Rd Ste 204, Southampton, PA 18966. The listed phone number is (415) 802-1310.

What is Dermatology Specialists Of Pennsylvania's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Dermatology Specialists Of Pennsylvania enrolled in Medicare?

Yes. Dermatology Specialists Of Pennsylvania is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dermatology Specialists Of Pennsylvania?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Dermatology Specialists Of Pennsylvania, in Dermatology, Micrographic Dermatologic Surgery (MDS) and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Dermatology Specialists Of Pennsylvania was last updated on August 5, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.