MEDICARE: RUTABA TAJAMMAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD482255	PA
2	207R00000X	Internal Medicine Physician	291875	MA

General Provider Information

NPI Number	:	1144880311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTABA TAJAMMAL

Provider Business Mailing Address
First Line	:	20130 ROUTE 19 STE 1000
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6218
Country	:	US
Telephone Number	:	724-779-7400
Fax Number	:	724-779-7401

Provider Business Practice Location Address
First Line	:	20130 ROUTE 19 STE 1000
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6218
Country	:	US
Telephone Number	:	716-898-4578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	10/12/2023

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Directions to “ RUTABA TAJAMMAL ” Practice Location

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