MEDICARE: OBOT GRACE TIGAH DNP

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	363LW0102X	Women's Health Nurse Practitioner	SP028596	PA

General Provider Information

NPI Number	:	1356941157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OBOT GRACE TIGAH DNP

Provider Business Mailing Address
First Line	:	1500 CHESTNUT ST STE 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2700
Country	:	US
Telephone Number	:	267-225-2313
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 CHESTNUT ST
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3156
Country	:	US
Telephone Number	:	215-351-5500
Fax Number	:

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	01/21/2026

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