Provider Demographics
NPI:1093751992
Name:ATILLASOY, ERCEM S (MD)
Entity Type:Individual
Prefix:
First Name:ERCEM
Middle Name:S
Last Name:ATILLASOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-0552
Mailing Address - Country:US
Mailing Address - Phone:215-672-5260
Mailing Address - Fax:215-672-5287
Practice Address - Street 1:331 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2033
Practice Address - Country:US
Practice Address - Phone:215-672-5260
Practice Address - Fax:215-672-5287
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053024L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0715802000OtherINDEPENDENCE BLUE CROSS
008142H8PMedicare ID - Type Unspecified
PA0715802000OtherINDEPENDENCE BLUE CROSS