Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | OS021442 | PA |
NPI | 1801243092 |
---|---|
Provider Name | Dr. Tara Gaston Moncman |
First Address | Philadelphia, PA 19106-3420 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 22/07/2021 |