Provider Demographics
NPI:1225278963
Name:TARA LYN CUDA, D.O., P.C.
Entity Type:Organization
Organization Name:TARA LYN CUDA, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:CUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-334-3869
Mailing Address - Street 1:2230 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3950
Mailing Address - Country:US
Mailing Address - Phone:215-334-3869
Mailing Address - Fax:215-755-3300
Practice Address - Street 1:2230 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3950
Practice Address - Country:US
Practice Address - Phone:215-334-3869
Practice Address - Fax:215-755-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2038856OtherHBS