Main Line Center for Skin Surgery, Inc

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

MD-047761-L Issued in PA

Legal business name

MAIN LINE CENTER FOR SKIN SURGERY, INC

Practice address

822 Montgomery Ave
Suite 110
Narberth, PA 19072-1937

Phone

(484) 343-8751

NPI assigned

Jun 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tatyana R Humphreys, M.D.

Title

President

Phone

(484) 343-8751

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186531200000",
    "number": "1346443496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 GYPSY LN",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190961103",
            "telephone_number": "484-343-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 MONTGOMERY AVE",
            "address_2": "SUITE 110",
            "city": "NARBERTH",
            "state": "PA",
            "postal_code": "190721937",
            "telephone_number": "484-343-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE CENTER FOR SKIN SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2007-08-08",
        "status": "A",
        "authorized_official_last_name": "HUMPHREYS",
        "authorized_official_first_name": "TATYANA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "484-343-8751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "PA",
            "license": "MD-047761-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Narberth, PA
• Providers in Narberth, PA by specialty
• MOHS-Micrographic Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2007; 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.