Basic Information
| Provider Information | |||||||||
| NPI: | 1568621126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEGNAN | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DH PHYSICIANS PO BOX 829641 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673705296 | ||||||||
| FaxNumber: | 2152303725 | ||||||||
| Practice Location | |||||||||
| Address1: | 4897 YORK ROAD | ||||||||
| Address2: | BUCKINGHAM FAMILY MEDICINE | ||||||||
| City: | BUCKINGHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189120278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157947471 | ||||||||
| FaxNumber: | 2157942576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2008 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD433592 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102240949 | 05 | PA | MEDICAID |