Healthcare Provider Details

I. General information

NPI: 1073910923
Provider Name (Legal Business Name): TONY ABDELMASEEH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TONY TANAGHO M.D

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

IV. Provider business mailing address

5 S WASHINGTON AVE
JERMYN PA
18433-1121
US

V. Phone/Fax

Practice location:
  • Phone: 570-230-0019
  • Fax: 570-230-0013
Mailing address:
  • Phone: 570-230-0019
  • Fax: 570-230-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD461253
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD461253
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: