Provider Demographics
NPI:1346292901
Name:TABBY, DAVID STUART (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:STUART
Last Name:TABBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SPRINGHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1114
Mailing Address - Country:US
Mailing Address - Phone:610-635-8520
Mailing Address - Fax:610-546-7604
Practice Address - Street 1:217 SPRINGHOUSE LN
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1114
Practice Address - Country:US
Practice Address - Phone:610-635-8520
Practice Address - Fax:610-546-7604
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005577L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001126105Medicaid
PAC34758Medicare UPIN
PA512293Medicare ID - Type Unspecified