Provider Demographics
NPI:1003966839
Name:MALARA, TANIA J (OD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:J
Last Name:MALARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2045
Mailing Address - Country:US
Mailing Address - Phone:215-672-9030
Mailing Address - Fax:215-672-8099
Practice Address - Street 1:345 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2045
Practice Address - Country:US
Practice Address - Phone:215-672-9030
Practice Address - Fax:215-672-8099
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPOP130152W00000X
MN3839152W00000X
WI3844-35152W00000X
VA0618003191152W00000X
PAOEG001871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist