Provider Demographics
NPI:1114008372
Name:BLOCK WIENER, TAMAR A (PAC)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:A
Last Name:BLOCK WIENER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:TAMAR
Other - Middle Name:A
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 848269
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8269
Mailing Address - Country:US
Mailing Address - Phone:610-973-1700
Mailing Address - Fax:610-973-1779
Practice Address - Street 1:250 CETRONIA ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9168
Practice Address - Country:US
Practice Address - Phone:610-973-6200
Practice Address - Fax:610-973-6546
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052662363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052662OtherPA LICENSE NUMBER
PA50063512OtherBLUE CROSS/KEYSTONE CENTRAL
PA105894EDCMedicare PIN