=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720015308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN S TARAS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2006
-----------------------------------------------------
Last Update Date | 03/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216-220 N. BROAD STREET 2ND FLOOR, FEINSTEIN BUILDING
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-762-2663
-----------------------------------------------------
Fax | 215-762-4447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 MARKET ST 24TH FLOOR-WEST TOWER
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-255-3828
-----------------------------------------------------
Fax | 215-255-3577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | MD045154E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | MA054808
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | MD045154E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | MA054808
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 2086S0105X
-----------------------------------------------------
Taxonomy Name | Surgery of the Hand (Surgery) Physician
-----------------------------------------------------
License Number | MD045154E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 2086S0105X
-----------------------------------------------------
Taxonomy Name | Surgery of the Hand (Surgery) Physician
-----------------------------------------------------
License Number | MA054808
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 2251H1200X
-----------------------------------------------------
Taxonomy Name | Hand Physical Therapist
-----------------------------------------------------
License Number | MD045154E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 2251H1200X
-----------------------------------------------------
Taxonomy Name | Hand Physical Therapist
-----------------------------------------------------
License Number | MA054808
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number | MD045154E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number | MA054808
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------