Organization
PHILADELPHIA CENTER FOR DERMATOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ATSUKO KODAMA M.D. (OWNER)
(267) 538-5045
Entity
Organization
Contact information
Practice address
8400 ROOSEVELT BLVD, SUITE 200, PHILADELPHIA, PA 19152-2081
(267) 538-5045
(267) 538-2153
Mailing address
8400 ROOSEVELT BLVD, SUITE 200, PHILADELPHIA, PA 19152-2081
(267) 538-5045
(267) 538-2153
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
MD440883
PA
207NS0135X
Procedural Dermatology Physician
MD440883
PA
Other
Enumeration date
05/13/2014
Last updated
08/22/2014
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