Individual
DR. TATYANA HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
306 GYPSY LN, WYNNEWOOD, PA 19096-1103
(484) 343-8751
(610) 572-7262
Mailing address
306 GYPSY LN, WYNNEWOOD, PA 19096-1103
(484) 343-8751
(610) 572-7262
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
MD047761L
PA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
MD047761L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016592
—
PA
05
—
7582706
—
NJ
Enumeration date
07/21/2006
Last updated
09/29/2020
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