Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 0101236929 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 25MA08860400 | NJ |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD441292 | PA |
NPI | 1073585907 |
---|---|
Provider Name | Dr. Thomas Daniel Regan |
First Address | Ambler, PA 19002-2172 |
Second Address | Philadelphia, PA 19107-6187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 27/05/2013 |