Healthcare Provider Details

I. General information

NPI: 1770849440
Provider Name (Legal Business Name): TALAR TATARIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2012
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST STE 500
PHILADELPHIA PA
19107-5563
US

IV. Provider business mailing address

1300 WOLF ST FL 1
PHILADELPHIA PA
19148-2912
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number293675
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD452643
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: