Organization
MAIN LINE CENTER FOR SKIN SURGERY, INC
Active
Organization
MAIN LINE CENTER FOR SKIN SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TATYANA R HUMPHREYS M.D. (PRESIDENT)
(484) 343-8751
Entity
Organization
Contact information
Practice address
822 MONTGOMERY AVE, SUITE 110, NARBERTH, PA 19072-1937
(484) 343-8751
Mailing address
306 GYPSY LN, WYNNEWOOD, PA 19096-1103
(484) 343-8751
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
MD-047761-L
PA
Other
Enumeration date
06/07/2007
Last updated
08/08/2007
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