Basic Information
| Provider Information | |||||||||
| NPI: | 1093751992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATILLASOY | ||||||||
| FirstName: | ERCEM | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 552 | ||||||||
| Address2: | |||||||||
| City: | HATBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190400552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156725260 | ||||||||
| FaxNumber: | 2156725287 | ||||||||
| Practice Location | |||||||||
| Address1: | 331 N YORK RD | ||||||||
| Address2: | |||||||||
| City: | HATBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190402033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156725260 | ||||||||
| FaxNumber: | 2156725287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD053024L | PA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 0715802000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER |