Provider Demographics
NPI:1609978741
Name:O'CONNOR, TANYA (DO)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:175 MARTIN AVENUE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9550
Mailing Address - Country:US
Mailing Address - Phone:717-721-5700
Mailing Address - Fax:717-715-1296
Practice Address - Street 1:175 MARTIN AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1761
Practice Address - Country:US
Practice Address - Phone:717-721-5700
Practice Address - Fax:717-715-1296
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA05009575L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA127983OtherTHREE RIVERS
PA16736950008Medicaid
PA5113495OtherUSH/HMO
PA500551204OtherCAPITAL BLUE SHIELD
PA160048492OtherRRMCR
PA76342OtherBLUE SHIELD
PA1513422OtherGATEWAY
PA5113495OtherAETNA
PA5113495OtherUSH/HMO