Provider Demographics
NPI:1043501265
Name:TADROUS, KATHREEN THARWAT (MD)
Entity Type:Individual
Prefix:
First Name:KATHREEN
Middle Name:THARWAT
Last Name:TADROUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHREEN
Other - Middle Name:THARWAT
Other - Last Name:GEORGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 E. JERSEY SREET
Mailing Address - Street 2:TRINITAS REGIONAL MEDICAL CENTER
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206
Mailing Address - Country:US
Mailing Address - Phone:908-994-7455
Mailing Address - Fax:
Practice Address - Street 1:655 E. JERSEY SREET
Practice Address - Street 2:TRINITAS REGIONAL MEDICAL CENTER
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206
Practice Address - Country:US
Practice Address - Phone:908-994-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA097919002084P0804X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program