NPIMap

Organization Active NPI

Philadelphia Center for Dermatology, PC

  • Dermatopathology Physician
  • Philadelphia, PA
National Provider Identifier
1598176554
Registry record updated Aug 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
MD440883 Issued in PA
Legal business name
PHILADELPHIA CENTER FOR DERMATOLOGY, PC
Practice address
8400 Roosevelt Blvd
Suite 200
Philadelphia, PA 19152-2081
Phone
(267) 538-5045
Fax
(267) 538-2153
NPI assigned
May 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2014

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

Authorized official

Name
Atsuko Kodama, M.D.NPI 1699976340
Title
Owner
Phone
(267) 538-5045

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X MD440883 PA Primary
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X MD440883 PA

Addresses

Primary practice location

8400 Roosevelt Blvd
Suite 200
Philadelphia, PA 19152-2081

Mailing address

8400 Roosevelt Blvd
Suite 200
Philadelphia, PA 19152-2081
Phone (267) 538-5045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140813000149 PA Part B Supplier - Clinic/Group Practice 4082831219 Receives reassigned benefits from 1 practitioner
Practice locations: Jenkintown, PA

National Provider Directory

National Provider Directory

Locations

361 Highland Ave
Ste 204
Jenkintown, PA 19046
Phone (267) 538-5045

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1598176554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 ROOSEVELT BLVD",
            "address_2": "SUITE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522081",
            "telephone_number": "267-538-5045",
            "fax_number": "267-538-2153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 ROOSEVELT BLVD",
            "address_2": "SUITE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191522081",
            "telephone_number": "267-538-5045",
            "fax_number": "267-538-2153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA CENTER FOR DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "KODAMA",
        "authorized_official_first_name": "ATSUKO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "267-538-5045",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "PA",
            "license": "MD440883",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "PA",
            "license": "MD440883",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.