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General NPI Number Information
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NPI Number | 1073585907
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Entity Type | Individual
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Provider Name | THOMAS DANIEL REGAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 05/27/2013
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Provider Practice Location Address
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Address Line | 822 PINE ST SUITE 2A
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6187
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Country | US
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Telephone | 267-519-0154
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Fax | 267-519-0597
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Provider Business Mailing Address
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Address Line | 835 SPRING HOUSE FARM LN
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City | AMBLER
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State | PA
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Zip | 19002-2172
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Country | US
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Telephone | 619-977-6252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101236929
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 25MA08860400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | MD441292
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License Number State | PA
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