Provider Demographics
NPI:1780619759
Name:TAVANI, DEEBEANNE MARIE (DO PHD)
Entity type:Individual
Prefix:DR
First Name:DEEBEANNE
Middle Name:MARIE
Last Name:TAVANI
Suffix:
Gender:F
Credentials:DO PHD
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Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:LANKENAU MEDICAL BLDG EAST SUITE 463
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-5170
Mailing Address - Fax:610-896-5640
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:LANKENAU MEDICAL BLDG EAST SUITE 463
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-5170
Practice Address - Fax:610-896-5640
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006178L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1280660Medicaid
PA1280660Medicaid
PA709828Medicare PIN