Basic Information
| Provider Information | |||||||||
| NPI: | 1245725571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAM | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 FORBES AVENUE | ||||||||
| Address2: | FORBES TOWER - PLAZA LEVEL SUITE 140 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126476340 | ||||||||
| FaxNumber: | 4126475809 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 HOWARD AVENUE | ||||||||
| Address2: | SUITE F2 | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148892020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.