Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD047761L | PA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD047761L | PA |
NPI | 1184645731 |
---|---|
Provider Name | Dr. Tatyana Humphreys |
First Address | Wynnewood, PA 19096-1103 |
Second Address | Wynnewood, PA 19096-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016592 | (05) | PA |
7582706 | (05) | NJ |