Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 65639 | GA |
N | 207N00000X | Dermatologist | MD439815 | PA |
N | 207ND0900X | Dermatopathologist | 65638 | GA |
NPI | 1023080561 |
---|---|
Provider Name | Dr. Adar Berghoff |
First Address | Atlanta, GA 30342-1418 |
Second Address | Atlanta, GA 30342-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 10/12/2014 |