Provider Demographics
NPI:1710973920
Name:FELEGY, TANIA M (PAC)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:M
Last Name:FELEGY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LEHIGH ST
Mailing Address - Street 2:103
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3880
Mailing Address - Country:US
Mailing Address - Phone:610-628-8410
Mailing Address - Fax:610-628-8434
Practice Address - Street 1:1501 LEHIGH ST
Practice Address - Street 2:103
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3880
Practice Address - Country:US
Practice Address - Phone:610-628-8410
Practice Address - Fax:610-628-8434
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001626L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50047098OtherCBC
20014948OtherAMERIHEALTH MERCY
PA021729G1VMedicare PIN
50047098OtherCBC
PA970008064Medicare PIN