MEDICARE: DR. HERBERT TISNOWER M.D.

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	207Q00000X	Family Medicine Physician	MD028686E	PA
2	208D00000X	General Practice Physician	MD028686E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	080019943	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0035661000	OTHER	PA	PERSONAL CHOICE PPO OF PENNSYLVANIA (INDEPENDENT BLC)
3	0035661000	OTHER	PA	IBC PERSONAL CHOICE
4	232626909	OTHER	PA	TRICARE PALMETTO (REGIONS 1-6)
5	232626909	OTHER	PA	TRICARE FOR LIFE
7	0035661001	OTHER	PA	PENNSYLVANIA KEYSTONE HEALTH PLAN EAST
8	1831195619	OTHER	PA	KEYSTONE FIRST

General Provider Information

NPI Number	:	1831195619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT TISNOWER M.D.

Provider Business Mailing Address
First Line	:	1837 S 65TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1423
Country	:	US
Telephone Number	:	215-726-0181
Fax Number	:	215-726-5110

Provider Business Practice Location Address
First Line	:	1837 S 65TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-1423
Country	:	US
Telephone Number	:	215-726-0181
Fax Number	:	215-726-5110

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

Provider Enumeration Date	:	06/25/2005
Last Update Date	:	09/09/2022

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