Provider Demographics
NPI:1215497615
Name:VASE, TABITHA RACHELLE SHANNON (MD)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:RACHELLE SHANNON
Last Name:VASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:RACHELLE
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 CLAIRTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-5505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 CLAIRTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5505
Practice Address - Country:US
Practice Address - Phone:412-466-5004
Practice Address - Fax:412-466-7137
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA179736OtherMEDICAL BOARD OF CALIFORNIA