Provider Demographics
NPI:1477541068
Name:TATAR, BONNIE S (DPM)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:S
Last Name:TATAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 CENTRE AVE
Mailing Address - Street 2:L-1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3744
Mailing Address - Country:US
Mailing Address - Phone:412-361-3668
Mailing Address - Fax:412-361-4207
Practice Address - Street 1:5701 CENTRE AVE
Practice Address - Street 2:L-1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3744
Practice Address - Country:US
Practice Address - Phone:412-361-3668
Practice Address - Fax:412-361-4207
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003424-L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1275983Medicaid
PA467909Medicare ID - Type Unspecified
PA1275983Medicaid
PA6487250001Medicare NSC