Healthcare Provider Details

I. General information

NPI: 1932319639
Provider Name (Legal Business Name): SOLI F TAVARIA MC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N DELAWARE AVE
MINERSVILLE PA
17954
US

IV. Provider business mailing address

105 N DELAWARE AVE
MINERSVILLE PA
17954
US

V. Phone/Fax

Practice location:
  • Phone: 570-544-6424
  • Fax: 570-544-2734
Mailing address:
  • Phone: 570-544-6424
  • Fax: 570-544-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number000877
License Number StatePA

VIII. Authorized Official

Name: MR. SOLI F TAVARIA
Title or Position: OWNER
Credential: MD
Phone: 570-544-6424