Individual
GREGG ILAN KHODOROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MBA
Contact information
Practice address
1015 WALNUT ST STE 620, PHILADELPHIA, PA 19107-5005
(215) 955-6864
(215) 955-2878
Mailing address
60 PATERSON ST APT 803, NEW BRUNSWICK, NJ 08901-2142
(973) 303-2674
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
PA
Other
Enumeration date
04/09/2020
Last updated
04/09/2020
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