1790920338 NPI number — MRS. MARGARET MARY TAREILA P.T.

Table of content: MRS. MARGARET MARY TAREILA P.T. (NPI 1790920338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790920338 NPI number — MRS. MARGARET MARY TAREILA P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAREILA
Provider First Name:
MARGARET
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCONVILLE
Provider Other First Name:
MARGARET
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790920338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 BRIARWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLINGFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19086-6502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-566-4167
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-690-2520
Provider Business Practice Location Address Fax Number:
610-690-4645
Provider Enumeration Date:
12/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT003358L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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