MEDICARE: DORIS E TIRADO M.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	207V00000X	Obstetrics & Gynecology Physician	MD054294L	PA

General Provider Information

NPI Number	:	1386655512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS E TIRADO M.D.

Provider Business Mailing Address
First Line	:	1098 W BALTIMORE PIKE
Second Line	:	SUITE 3106 RIDDLE HLTH CTR 3
City	:	MEDIA
State	:	PA
Zip	:	19063-5139
Country	:	US
Telephone Number	:	610-891-6240
Fax Number	:	610-891-6244

Provider Business Practice Location Address
First Line	:	1098 W BALTIMORE PIKE
Second Line	:	SUITE 3106 RIDDLE HLTH CTR 3
City	:	MEDIA
State	:	PA
Zip	:	19063-5139
Country	:	US
Telephone Number	:	610-891-6240
Fax Number	:	610-891-6244

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	12/31/2014

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Directions to “ DORIS E TIRADO M.D.” Practice Location

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