Healthcare Provider Details

I. General information

NPI: 1043205768
Provider Name (Legal Business Name): DOUGLAS KLIGMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 GERMANTOWN AVE SUITE 30
PHILADELPHIA PA
19118-2722
US

IV. Provider business mailing address

8815 GERMANTOWN AVE SUITE 30
PHILADELPHIA PA
19118-2722
US

V. Phone/Fax

Practice location:
  • Phone: 215-242-4680
  • Fax: 215-242-3938
Mailing address:
  • Phone: 215-242-4680
  • Fax: 215-242-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD052503L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: