MEDICARE: DR. ANNE W TAX PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS006053L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0510104000	OTHER	PA	PERSONAL CHOICE
2	TA676609	OTHER	PA	HIGHMARK BLUE CROSS

General Provider Information

NPI Number	:	1316002009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE W TAX PH.D.

Provider Business Mailing Address
First Line	:	1656 SUSQUEHANNA RD
Second Line	:
City	:	RYDAL
State	:	PA
Zip	:	19046-1431
Country	:	US
Telephone Number	:	215-887-8188
Fax Number	:	215-887-9033

Provider Business Practice Location Address
First Line	:	9733 BUSTLETON AVE
Second Line	:	SUITE 2N
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-3201
Country	:	US
Telephone Number	:	215-887-7616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2006
Last Update Date	:	07/08/2007

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