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General NPI Number Information
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NPI Number | 1093165540
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Entity Type | Individual
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Provider Name | DIANA TACELOSKY M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 10/19/2024
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Provider Practice Location Address
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Address Line | 701 W OAK ST
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City | FRACKVILLE
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State | PA
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Zip | 17931-1672
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Country | US
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Telephone | 570-874-4100
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Fax | 570-874-4182
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Provider Business Mailing Address
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Address Line | 701 W OAK ST
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City | FRACKVILLE
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State | PA
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Zip | 17931-1672
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Country | US
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Telephone | 570-874-4100
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Fax | 570-874-4182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0116029131
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD482087
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License Number State | PA
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