Provider Demographics
NPI:1336440403
Name:MUIR, TAMARA LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEIGH
Last Name:MUIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 MARTINGALE ROAD
Mailing Address - Street 2:
Mailing Address - City:SCHWENKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19473
Mailing Address - Country:US
Mailing Address - Phone:215-630-8982
Mailing Address - Fax:
Practice Address - Street 1:63 DAWSON RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8101
Practice Address - Country:US
Practice Address - Phone:215-630-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002577363A00000X
PAMA054728363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant