| Organization Name: | DERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA |
| NPI Number: | 1053417055 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH E BLOOM (PRESIDENT) |
| Mailing Address: | 2795 Pilot Knob Rd Suite 300 Eagan |
| State: | MN US |
| Postal Code: | 551211176 |
| Phone Number: | 6513799999 |
| Fax Number: | 6513799900 |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207NP0225X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Dermatology |
| Taxonomy Specialization: | Pediatric Dermatology |
| Taxonomy Definition: | A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents. |