=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942578414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMA SENICK PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2011
-----------------------------------------------------
Last Update Date | 12/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3131 COLLEGE HEIGHTS BLVD STE 1200
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-4858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 106-439-8551
-----------------------------------------------------
Fax | 610-439-1435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3131 COLLEGE HEIGHTS BLVD STE 1200
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18104-4858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 106-439-8551
-----------------------------------------------------
Fax | 610-439-1435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | OA002751
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA055184
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------