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General NPI Number Information
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NPI Number | 1528080512
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Entity Type | Organization
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Legal Business Name | KENNETH E WASSERMAN MD PC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1817 SOUTH BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2115
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Country | US
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Telephone | 215-334-1300
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Fax | 215-334-0549
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Provider Business Mailing Address
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Address Line | 1817 SOUTH BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2115
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Country | US
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Telephone | 215-334-1300
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Fax | 215-334-0549
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH E WASSERMAN
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Credential | MD
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Telephone | 215-334-1300
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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 | MD031626E
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License Number State | PA
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