Provider Demographics
NPI:1326088600
Name:LAWLOR, TARA HEINTZ (DO)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:HEINTZ
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2901 ST. LAWRENCE AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2266
Mailing Address - Country:US
Mailing Address - Phone:610-301-0306
Mailing Address - Fax:610-628-9011
Practice Address - Street 1:2901 ST. LAWRENCE AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2266
Practice Address - Country:US
Practice Address - Phone:610-301-0306
Practice Address - Fax:610-592-9333
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-09-03
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Provider Licenses
StateLicense IDTaxonomies
PAOS013616207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124848ZQM0Medicare PIN
PA102882Medicare PIN
PAI57816Medicare UPIN