Healthcare Provider Details

I. General information

NPI: 1235280363
Provider Name (Legal Business Name): EDWARD JOSPEH TADAJWESKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 NORMAN DR
LEBANON PA
17042-7497
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-274-5500
  • Fax: 717-202-0130
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD 422470
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: