Provider Demographics
NPI:1235104746
Name:GOSS, TAMARA A (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:A
Last Name:GOSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2025
Mailing Address - Country:US
Mailing Address - Phone:610-543-4331
Mailing Address - Fax:610-543-4331
Practice Address - Street 1:101 S MORTON AVE
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19070-2025
Practice Address - Country:US
Practice Address - Phone:610-543-4331
Practice Address - Fax:610-543-4331
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003943L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032673Medicaid
PA1032673Medicaid