Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD440883 | PA |
N | 207N00000X | Dermatologist | N7443 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD440883 | PA |
N | 207ND0900X | Dermatopathologist | MD440883 | PA |
NPI | 1699976340 |
---|---|
Provider Name | Atsuko Kodama |
First Address | Philadelphia, PA 19152-2081 |
Second Address | Philadelphia, PA 19152-2081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BP2-0029752 | INSTITUTIONAL PERMIT (01) |