Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD451344 | PA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD451344 | PA |
NPI | 1437444973 |
---|---|
Provider Name | Adam J Tyson |
First Address | Paoli, PA 19301-1763 |
Second Address | Paoli, PA 19301-1763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 31/08/2016 |