Provider Demographics
NPI:1336103993
Name:TYRALA, EILEEN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:ELIZABETH
Last Name:TYRALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3300 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1121
Mailing Address - Country:US
Mailing Address - Phone:215-438-3300
Mailing Address - Fax:215-438-4079
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-334-8341
Practice Address - Fax:610-649-4735
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2018-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019246E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34459Medicare UPIN