Provider Demographics
NPI:1003800541
Name:ILYAS, ERUM N (MD)
Entity Type:Individual
Prefix:
First Name:ERUM
Middle Name:N
Last Name:ILYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERUM
Other - Middle Name:N
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:860 FIRST AVE
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-265-1166
Mailing Address - Fax:215-265-1186
Practice Address - Street 1:860 FIRST AVE
Practice Address - Street 2:SUITE 8B
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-265-1166
Practice Address - Fax:215-265-1186
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424557207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology