Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD424557 | PA |
NPI | 1003800541 |
---|---|
Provider Name | Erum N Ilyas |
First Address | King Of Prussia, PA 19406-4033 |
Second Address | King Of Prussia, PA 19406-4033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 01/05/2012 |