Provider Demographics
NPI:1184799868
Name:GABRIEL T TATARIAN, DO, LLC
Entity type:Organization
Organization Name:GABRIEL T TATARIAN, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-922-1801
Mailing Address - Street 1:1015 CHESTNUT ST STE 918
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4309
Mailing Address - Country:US
Mailing Address - Phone:215-922-1801
Mailing Address - Fax:
Practice Address - Street 1:1015 CHESTNUT ST STE 918
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-922-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-03-13
Deactivation Date:2018-08-23
Deactivation Code:
Reactivation Date:2018-08-24
Provider Licenses
StateLicense IDTaxonomies
PAOS008458L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01465075Medicaid
PA760939Medicare ID - Type Unspecified
PA01465075Medicaid