Healthcare Provider Details

I. General information

NPI: 1730327651
Provider Name (Legal Business Name): TAMARA J KANE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA JOY TWARDOWSKI PA-C

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 LAKEVIEW DR N SUITE 202
GIBBSBORO NJ
08026-1026
US

IV. Provider business mailing address

63 LAKEVIEW DR N SUITE 202
GIBBSBORO NJ
08026-1026
US

V. Phone/Fax

Practice location:
  • Phone: 856-435-6000
  • Fax: 856-782-1667
Mailing address:
  • Phone: 856-435-6000
  • Fax: 856-782-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00213700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: