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General NPI Number Information
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NPI Number | 1689105769
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Entity Type | Individual
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Provider Name | TYLER RAINER B.A.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD SUITE M975
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3364
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Country | US
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Telephone | 215-327-4964
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 CIVIC CENTER BLVD SUITE M975
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3364
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Country | US
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Telephone | 215-327-4964
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 272481
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | S69718078
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | MD480549
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License Number State | PA
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