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General NPI Number Information
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NPI Number | 1932319639
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Entity Type | Organization
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Legal Business Name | SOLI F TAVARIA MC PC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 105 N DELAWARE AVE
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City | MINERSVILLE
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State | PA
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Zip | 17954
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Country | US
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Telephone | 570-544-6424
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Fax | 570-544-2734
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Provider Business Mailing Address
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Address Line | 105 N DELAWARE AVE
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City | MINERSVILLE
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State | PA
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Zip | 17954
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Country | US
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Telephone | 570-544-6424
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Fax | 570-544-2734
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Authorized Official
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Title or Position | OWNER
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Name | MR. SOLI F TAVARIA
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Credential | MD
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Telephone | 570-544-6424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 000877
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License Number State | PA
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