Provider Demographics
NPI:1639469950
Name:TIWARY, TARKESHWAR (MD)
Entity Type:Individual
Prefix:
First Name:TARKESHWAR
Middle Name:
Last Name:TIWARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:601 NORLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4235
Practice Address - Country:US
Practice Address - Phone:717-264-1600
Practice Address - Fax:717-264-6319
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448765207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102828160 0001Medicaid
PA8807457OtherAETNA HMO
PAP01192077OtherRAILROAD MEDICARE
PA002886854OtherHIGHMARK BLUE SHIELD
PA4861383OtherAETNA NON HMO
PA291240LN7Medicare PIN