Provider Demographics
NPI:1063452035
Name:TADDUNI, GREGORY T (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:TADDUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BARTOL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2214
Mailing Address - Country:US
Mailing Address - Phone:610-521-8970
Mailing Address - Fax:610-521-3983
Practice Address - Street 1:1 BARTOL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2214
Practice Address - Country:US
Practice Address - Phone:610-521-8970
Practice Address - Fax:610-521-3983
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030939E207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011442200003Medicaid
PAE64271Medicare UPIN
PA0011442200003Medicaid