Healthcare Provider Details

I. General information

NPI: 1174848071
Provider Name (Legal Business Name): DHANASHRI PANDURANG MISKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WALNUT ST FL 2
PHILADELPHIA PA
19107-5191
US

IV. Provider business mailing address

900 WALNUT ST FL 2
PHILADELPHIA PA
19107-5191
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6871
  • Fax: 215-503-2990
Mailing address:
  • Phone: 215-955-6871
  • Fax: 215-503-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD465374
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number274141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: