Provider Demographics
NPI:1780663427
Name:SOLI F TAVARIA MD PC
Entity Type:Organization
Organization Name:SOLI F TAVARIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLI
Authorized Official - Middle Name:F
Authorized Official - Last Name:TAVARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-544-6424
Mailing Address - Street 1:105 N DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1726
Mailing Address - Country:US
Mailing Address - Phone:570-544-6424
Mailing Address - Fax:570-544-2734
Practice Address - Street 1:105 N DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1726
Practice Address - Country:US
Practice Address - Phone:570-544-6424
Practice Address - Fax:570-544-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
880841Medicare ID - Type Unspecified