MEDICARE: DR. PAMELA A TEDESCO DO

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	207Q00000X	Family Medicine Physician	OS007895L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	232359401	OTHER	PA	MAIN LINE HEALTHCARE

General Provider Information

NPI Number	:	1417927179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA A TEDESCO DO

Provider Business Mailing Address
First Line	:	1161 MCDERMOTT DR
Second Line	:	SUITE 101
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4064
Country	:	US
Telephone Number	:	610-701-7011
Fax Number	:	610-429-5199

Provider Business Practice Location Address
First Line	:	1161 MCDERMOTT DR
Second Line	:	SUITE 101
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4064
Country	:	US
Telephone Number	:	610-701-7011
Fax Number	:	610-429-5199

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	09/24/2014

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Directions to “ DR. PAMELA A TEDESCO DO” Practice Location

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