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General NPI Number Information
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NPI Number | 1699976340
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Entity Type | Individual
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Provider Name | ATSUKO KODAMA MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 361 HIGHLAND AVE STE 204
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City | JENKINTOWN
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State | PA
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Zip | 19046-2632
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Country | US
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Telephone | 267-538-5045
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Fax |
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Provider Business Mailing Address
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Address Line | 361 HIGHLAND AVE STE 204
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City | JENKINTOWN
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State | PA
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Zip | 19046-2632
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Country | US
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Telephone | 267-538-5045
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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 | N7443
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License Number State | TX
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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 | MD440883
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | MD440883
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD440883
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License Number State | PA
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