Provider Demographics
NPI:1194907345
Name:BONNIE TATAR
Entity type:Organization
Organization Name:BONNIE TATAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TATAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-361-3668
Mailing Address - Street 1:5701 CENTRE AVE STE L1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3744
Mailing Address - Country:US
Mailing Address - Phone:412-361-3668
Mailing Address - Fax:412-361-4207
Practice Address - Street 1:5701 CENTRE AVE STE L1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3744
Practice Address - Country:US
Practice Address - Phone:412-361-3668
Practice Address - Fax:412-361-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003424-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1275983Medicaid
PA121938Medicare PIN
PAU12604Medicare UPIN