Provider Demographics
NPI:1023288495
Name:LONDON, VANESSA AYUMI (MD, MS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:AYUMI
Last Name:LONDON
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:9501 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1025
Mailing Address - Country:US
Mailing Address - Phone:215-464-7400
Mailing Address - Fax:215-464-8680
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 508
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1025
Practice Address - Country:US
Practice Address - Phone:215-464-7400
Practice Address - Fax:215-464-8680
Is Sole Proprietor?:No
Enumeration Date:2008-03-02
Last Update Date:2010-08-18
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Provider Licenses
StateLicense IDTaxonomies
CAA101617207N00000X
PAMD439500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183846V4BMedicare PIN