Montgomery Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD424557 Issued in PA

Legal business name

MONTGOMERY DERMATOLOGY, LLC

Practice address

491 Allendale Rd
Suite 302
King of Prussia, PA 19406-1426

Phone

(610) 265-1166

Fax

(610) 265-1186

NPI assigned

Apr 3, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Erum Naseem Ilyas, MD

Title

President

Phone

(215) 694-4851

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238716800000",
    "number": "1124260211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "491 ALLENDALE RD",
            "address_2": "SUITE 302",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061426",
            "telephone_number": "610-265-1166",
            "fax_number": "610-265-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 ALLENDALE RD",
            "address_2": "SUITE 302",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194061426",
            "telephone_number": "610-265-1166",
            "fax_number": "610-265-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-03",
        "last_updated": "2009-04-03",
        "status": "A",
        "authorized_official_last_name": "ILYAS",
        "authorized_official_first_name": "ERUM",
        "authorized_official_middle_name": "NASEEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-694-4851",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD424557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in King of Prussia, PA
• Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.