Provider Demographics
NPI:1649472978
Name:ROYER, TRICIA LEE (DO)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:LEE
Last Name:ROYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST STE 1020
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4310
Mailing Address - Country:US
Mailing Address - Phone:215-955-7785
Mailing Address - Fax:215-955-9362
Practice Address - Street 1:1015 CHESTNUT ST STE 1020
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4310
Practice Address - Country:US
Practice Address - Phone:215-955-7785
Practice Address - Fax:215-955-9362
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017189207R00000X, 390200000X
PAOS016607207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program