Provider Demographics
NPI:1376595397
Name:TYRELL, DEAN ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:ANTHONY
Last Name:TYRELL
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 1:95 HIGHLAND AVE 130
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9483
Mailing Address - Country:US
Mailing Address - Phone:610-868-1100
Mailing Address - Fax:610-868-1111
Practice Address - Street 1:425 BRIGHTON ST
Practice Address - Street 2:#303
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1273
Practice Address - Country:US
Practice Address - Phone:610-868-1100
Practice Address - Fax:610-868-1111
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010303L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001863395Medicaid
PA001863395Medicaid
PA081713Medicare ID - Type Unspecified