Healthcare Provider Details

I. General information

NPI: 1093751992
Provider Name (Legal Business Name): ERCEM S ATILLASOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 N YORK RD
HATBORO PA
19040-2033
US

IV. Provider business mailing address

PO BOX 552
HATBORO PA
19040-0552
US

V. Phone/Fax

Practice location:
  • Phone: 215-672-5260
  • Fax: 215-672-5287
Mailing address:
  • Phone: 215-672-5260
  • Fax: 215-672-5287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD053024L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: