Provider Demographics
NPI:1225140791
Name:DEEBEANNE M TAVANI DO PHD PC
Entity Type:Organization
Organization Name:DEEBEANNE M TAVANI DO PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEBEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO PHD
Authorized Official - Phone:610-896-5770
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MOB EAST SUITE 453E
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-5170
Mailing Address - Fax:610-896-5640
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MOB EAST SUITE 453E
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-5170
Practice Address - Fax:610-896-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S006178L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1280660Medicaid
PA1280660Medicaid
PA709828Medicare PIN