Provider Demographics
NPI:1457374704
Name:KHROM, TATIANA (MD)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:KHROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 OCEAN PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7868
Mailing Address - Country:US
Mailing Address - Phone:718-615-4000
Mailing Address - Fax:718-615-4004
Practice Address - Street 1:2797 OCEAN PKWY STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7868
Practice Address - Country:US
Practice Address - Phone:718-615-4000
Practice Address - Fax:718-615-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163439207N00000X, 207ND0101X
NY227196207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3K2791Medicare UPIN