Healthcare Provider Details

I. General information

NPI: 1790789733
Provider Name (Legal Business Name): IGOR LOMAZOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 11/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 OFFICE CENTER DR SUITE 195
FT WASHINGTON PA
19034-3220
US

IV. Provider business mailing address

501 OFFICE CENTER DR SUITE 195
FT WASHINGTON PA
19034-3220
US

V. Phone/Fax

Practice location:
  • Phone: 215-836-7900
  • Fax: 215-836-7923
Mailing address:
  • Phone: 215-836-7900
  • Fax: 215-836-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD421026
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD421026
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: