Healthcare Provider Details

I. General information

NPI: 1225278963
Provider Name (Legal Business Name): TARA LYN CUDA, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 S BROAD ST
PHILADELPHIA PA
19145-3950
US

IV. Provider business mailing address

2230 S BROAD ST
PHILADELPHIA PA
19145-3950
US

V. Phone/Fax

Practice location:
  • Phone: 215-334-3869
  • Fax: 215-755-3300
Mailing address:
  • Phone: 215-334-3869
  • Fax: 215-755-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TARA LYN CUDA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 215-334-3869