Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG001871 | PA |
NPI | 1003966839 |
---|---|
Provider Name | Tania J Malara |
First Address | Hatboro, PA 19040-2045 |
Second Address | Hatboro, PA 19040-2045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 19/01/2012 |