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General NPI Number Information
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NPI Number | 1588613988
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Entity Type | Organization
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Legal Business Name | TARA LYN CUDA DO PC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 2230 SOUTH BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145
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Country | US
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Telephone | 215-334-3869
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Fax | 215-755-3300
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Provider Business Mailing Address
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Address Line | 2230 SOUTH BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145
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Country | US
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Telephone | 215-334-3869
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Fax | 215-755-3300
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Authorized Official
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Title or Position | PRESIDENT
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Name | TARA LYN CUDA
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Credential | DO
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Telephone | 215-334-3869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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