Provider Demographics
NPI:1689972580
Name:MACCRONE, TYLER (EMT-BASIC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MACCRONE
Suffix:
Gender:M
Credentials:EMT-BASIC
Other - Prefix:MR
Other - First Name:TYLER
Other - Middle Name:DAVID
Other - Last Name:MACCRONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA EMT
Mailing Address - Street 1:155 SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074
Mailing Address - Country:US
Mailing Address - Phone:610-764-4009
Mailing Address - Fax:610-876-7068
Practice Address - Street 1:155 SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:PA
Practice Address - Zip Code:19074-1128
Practice Address - Country:US
Practice Address - Phone:610-764-4009
Practice Address - Fax:610-876-7068
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA109291146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109291OtherPA EMT #