Provider Demographics
NPI:1972573129
Name:JAN, TAYYABA SAEED (MD)
Entity type:Individual
Prefix:DR
First Name:TAYYABA
Middle Name:SAEED
Last Name:JAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7615 TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9345
Mailing Address - Country:US
Mailing Address - Phone:610-366-9990
Mailing Address - Fax:610-366-9930
Practice Address - Street 1:7615 TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9345
Practice Address - Country:US
Practice Address - Phone:610-366-9990
Practice Address - Fax:610-366-9930
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027729E2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0934920Medicaid
PA430186Medicare ID - Type Unspecified
PA0934920Medicaid