Individual
ELIZABETH DERHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
840 WALNUT ST STE 1230, PHILADELPHIA, PA 19107-5109
(215) 928-3041
(215) 928-3225
Mailing address
840 WALNUT ST STE 1230, PHILADELPHIA, PA 19107-5109
(215) 928-3041
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
25MA09094200
NJ
207W00000X
Ophthalmology Physician
Primary
MD451087
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
364763
MEDICARE
PA
Enumeration date
06/23/2008
Last updated
11/29/2017
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