Provider Demographics
NPI:1669415683
Name:PECHET, TAINE TAYARD (MD)
Entity type:Individual
Prefix:
First Name:TAINE
Middle Name:TAYARD
Last Name:PECHET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TAINE
Other - Middle Name:TAYARD VALERE
Other - Last Name:PECHET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3400 CIVIC CENTER BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5161
Mailing Address - Country:US
Mailing Address - Phone:215-615-5864
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 CIVIC CENTER BLVD FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5161
Practice Address - Country:US
Practice Address - Phone:215-615-5864
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07305200208600000X, 208G00000X
PAMD073603L208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPE1307068OtherBLUE SHIELD
PAPE1307068OtherBLUE SHIELD
PA050942Medicare PIN
PA00186672600001Medicare ID - Type Unspecified