Healthcare Provider Details

I. General information

NPI: 1215469580
Provider Name (Legal Business Name): TARA LAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CONESTOGA RD STE 104
BRYN MAWR PA
19010-1352
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-6400
  • Fax: 610-525-1801
Mailing address:
  • Phone: 610-482-4795
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD472958
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: