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General NPI Number Information
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NPI Number | 1942664628
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Entity Type | Individual
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Provider Name | MARISSA ANNE MILCHAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 1516 LOCUST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4409
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Country | US
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Telephone | 215-545-5458
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Fax |
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Provider Business Mailing Address
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Address Line | 569 W LANCASTER AVE
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City | HAVERFORD
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State | PA
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Zip | 19041-1416
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Country | US
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Telephone |
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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 | MD471683
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License Number State | PA
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