Provider Demographics
NPI:1124085725
Name:FEDEC, TAMARA B (DO)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:B
Last Name:FEDEC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:301 E CITY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1708
Mailing Address - Country:US
Mailing Address - Phone:610-617-1300
Mailing Address - Fax:610-617-0199
Practice Address - Street 1:301 E CITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-617-1300
Practice Address - Fax:610-617-0199
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-006164-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1144945Medicaid
PAE79110Medicare UPIN
PA1144945Medicaid