Healthcare Provider Details

I. General information

NPI: 1932003381
Provider Name (Legal Business Name): M DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W RIDGE PIKE STE D-102
CONSHOHOCKEN PA
19428-3215
US

IV. Provider business mailing address

625 W RIDGE PIKE STE D-102
CONSHOHOCKEN PA
19428-3215
US

V. Phone/Fax

Practice location:
  • Phone: 310-283-9256
  • Fax:
Mailing address:
  • Phone: 310-283-9256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ELENI MCGEEHIN
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 310-283-9256