Provider Demographics
NPI:1992138556
Name:TAYAG, MARIE CHARISSE SILVA (MD)
Entity type:Individual
Prefix:
First Name:MARIE CHARISSE
Middle Name:SILVA
Last Name:TAYAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARISSE
Other - Middle Name:
Other - Last Name:TAYAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4910
Mailing Address - Country:US
Mailing Address - Phone:570-271-6211
Mailing Address - Fax:
Practice Address - Street 1:GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-4910
Practice Address - Country:US
Practice Address - Phone:570-271-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT205375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine